Cystohysteroscopy: Novel Use of Semi-Rigid Ureteroscope to Establish an Access via Fistulous Tract Between Urinary Bladder and Vagina for Confirming the Diagnosis and Facilitating Laparoscopic Repair of Vesicouterine Fistula

Abstract

In patients with vesicouterine fistula (VUF), identification of the fistulous tract during laparoscopic surgery remains difficult. Hysterography and intravesical instillation of dye have been the traditional methods for diagnosing VUF; now, they have been supplanted by ultrasonography, CT, and/or MRI. Unfortunately, none of the above mentioned investigations aid in identification of the fistulous tract during laparoscopic surgery or ease laparoscopic dissection. We describe a simple procedure, which we term cystohysteroscopy, that aids the diagnosis of VUF and also simplifies laparoscopic dissection. A guidewire/ureteral catheter is coiled in the uterine cavity through the fistulous tract with the help of a cystoscope. By cystohysteroscopy, this guidewire/ureteral catheter is pulled out through the vagina using a semirigid ureteroscope. The advantage of cystohysteroscopy is that the presence of the guidewire/ureteral catheter across the fistulous tract aids laparoscopic dissection even in the presence of fibrosis and can be used for traction/manipulation during dissection in the vesicouterine area. This is the first report in the literature depicting the use of a semirigid ureteroscope for the purpose of cystohysteroscopy.