PMC6556310_01
Cystoscopy performed before surgery. A: left ureteral meatus; B: fistulous orifice.
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Cystoscopy was then performed and revealed a 3mm diameter infratrigonal fistulous lesion, right under the left meatus (Figure 1).
Transperitoneal view of open bladder: a white ureteral catheter positioned through urethra into left ureteral meatus.
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With the bladder well dissected, a transversal cystotomy was performed, to expose the vesical side of the fistula (Figures 2 and 3).
Fistula identification: in the transperitoneal view infratrigonal fistula is identified above the ureteral meatus.
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With the bladder well dissected, a transversal cystotomy was performed, to expose the vesical side of the fistula (Figures 2 and 3).
Fistula dissection is performed by separating vaginal and bladder sides.
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The fistula was dissected with a good margin of healthy tissue until vaginal side (Figure 4).
Vaginal side sutured by 3-0 barbed suture in 2 layers.
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The vesical side was closed in 2 layers, using the same suture (Figure 5).
Final appearance of the treated fistula after suture of bladder.
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In the end of procedure, a 4.7mm ureteral stent and an 18Fr bladder catheter were placed (Figure 6).