2025 Volume 21 Issue 1 Pages 96-101
The patient is a 48-year-old woman (G4P3) who underwent a total laparoscopic hysterectomy (TLH) for multiple uterine fibroids. She had a three histories of cesarean section, resulting severe adhesions between the bladder and the uterus. However, the surgery was completed without complications and she was discharged on the 4th postoperative day. Two weeks after TLH, she complained watery vaginal discharge and vesicovaginal fistula was diagnosed after indigo carmine test. Conservative treatment with a Forley catheter failed to resolve the issue, and transvaginal vesicovaginal fistula repair was performed on the 76th day after TLH. A balloon catheter was inserted into the bladder via the vagina to secure the surgical field. The procedure involved incision of the vaginal wall, dissection of the vaginal and bladder walls, and closure of both the bladder and vaginal walls. Postoperative recovery was uneventful for two weeks. The patient's history of multiple cesarean sections would result to strong adhesions between the bladder and the uterus. While hemostasis was achieved with an energy device during adhesion dissection, a small bladder injury might be occurred. It is important to prevent thermal bladder injuries during TLH. In this case, the transvaginal approach was less invasive and realized quick recovery compared to the transabdominal approach.
