JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 87

Abstracts
Introduction: Traditionally urologists have repaired vesicovaginal fistula (VVF) abdominally and gynaecologists
vaginally. We have reviewed the routes of repair in a 2 surgeon series of VVF managed at a tertiary referral centre
between 2000 and 2017 to see if this is still the case.
Materials and Methods: Review of a prospective database for all patients with VVF for details of all patients with
VVF from 2000. Data on patient demographics, fistula aetiology, route of repair and final outcome was recorded for
each consecutive 5 year period.
Results: 139 patients of median age 50 years (range
21-88) were referred with VVF during this period. 155 VVF
repairs were performed in these women; 62 via the
abdominal route and 93 via the vaginal route. Absolute
indications for abdominal repair are considered to be
requirement for simultaneous ureteric reimplantation
and/or clam cystoplasty, or early repair following abdominal procedure. Absolute indications for abdominal repair
were present in in 9 women; the remaining 53 women had
abdominal repair due to surgeon preference or access difficulty. The details of route of VVF repair, time period and
outcomes are shown in Figures 1 and 2.
Anatomical closure was achieved in 97% overall - with no
significant difference between abdominal or vaginal closure routes (P > 0.05).
Conclusion: Vaginal repair of VVF has become increasingly common in urologist's hands with excellent fistula
outcomes and should be the route of choice if there are
no absolute indications for abdominal repair.

87
had mixed UI (MUI) - all had persistent post-operative UI.
Persistent MUI was successfully managed with rectus fascial sling (n=3) and intravesical botulinum toxin (n=2) or
sacral neuromodulation (n=1). Persistent SUI was treated
successfully with rectus fascial sling (n=2). 1 patient had a
TVT-O which failed. Of the remaining transvaginal repair
cohort, 2 patients had new-onset post-operative SUI
treated successfully with laparoscopic colposuspension.
The final patient had a complex urethra-vesico-vaginal fistula and underwent clam ileocystoplasty, bladder neck closure and mitrofanoff channel formation. Continence and
channel function are preserved after 13 years.
Conclusion: UVF are rare with varying aetiology including MUT insertion.Vaginal repair of UVF is feasible for the
majority of cases. Persistent and new-onset UI occurs in
34.8% and requires surgical treatment with success rates
of 87.5%.
P10-9: Table 1.

P10-9 The outcomes of urethrovaginal fistula
repair
Barratt R1, Kotes S2, Pakzad M2, Hamid R2, Ockrim J2,
Greenwell T2
1Whipps Cross Hospital, London, United Kingdom, 2University
College London Hospital, United Kingdom

Introduction: Urethrovaginal fistulae (UVF) are rare in
the developed world. We report the outcomes of our
cohort undergoing UVF repair at a genitourinary fistulae
specialist centre.
Patients and Methods: A prospectively acquired database of patients with genitourinary fistulae was analysed.
24 patients had surgical repair of UVF over 11 years
(2004-2015). Median age was 53.3 years (range 26-78). All
patients had pre-operative cystourethroscopy and videourodynamics (VUDs), except 2 with concurrent vesicovaginal fistulae (VVF). Post-operative urinary incontinence
(UI) was investigated with repeat VUDs.
Results: Aetiology of UVF is outlined in Table 1. 23
(95.8%) patients underwent transvaginal repair of UVF
with Martius fat pad interposition. Successful anatomical
closure was achieved in 100%. Pre-operative VUDs
revealed 13.7% (3/22) had stress UI (SUI) and 13.7% (3/22)

P10-10 A prospective study of the safety
and outcomes of robotic-assisted laparoscopic
ureterolysis including a comparative analysis
with open ureterolysis in patients with
ureteric obstruction from retroperitoneal
fibrosis (RPF) managed in a Specialist RPF
Centre
Fernando A1, Challacombe B1, De La Rosa A1,
O'Brien T1
1Guy's and St Thomas' NHS Trust, London, United Kingdom

Introduction: Controversy exists around the optimal
management of ureteric obstruction caused by retroperitoneal fibrosis (RPF). Ureterolysis offers patients the
opportunity to have optimal ureteric drainage without
the need for long term stents. However, patients can be
reluctant to undergo major open surgery despite the
advantages of ureterolysis.We commenced a robotic ureterolysis program in January 2016 in an effort to deliver
similar outcomes to open surgery with potentially less
morbidity.

Table of Contents for the Digital Edition of JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018