D. Mukwege2, A. De Cort1, B. Cadière3, B. Mukanire Ntakwinja2, D. Guha-Sapir1 1Université Catholique De Louvain,Faculté De Medecine,Woluwe-Saint-Lambert, BRUSSELS, Belgium 2Hôpital De Panzi,Bukavu, SOUTH-KIVU, Congo 3The European School Of Laparoscopic Surgery,Department Of Gastrointestinal Surgery,Brussels, BRUSSELS, Belgium
Introduction:
Onsrud et al. reported that 61% of ureterovaginal fistulae (UVF) in Eastern DRC are caused by Cesarean delivery, whereas in high-income countries, the main etiology of UVF is hysterectomy for benign uterine disease. Few studies have reported laparoscopic repair of UVF in a resource-limited setting and none with a high prevalence of post-Cesarean UVF.
Methods:
We conducted a prospective study of the 5 first patients diagnosed with UVF who underwent laparoscopic ureteroneocystostomy between November 2014 and February 2015. We collected data on patients' demographics and pre-operative, per-operative and post-operative data including costs. Surgical steps were described. A voiding cystourethrogram was performed 3 months post-operatively and we conducted a patient satisfaction questionnaire after follow-up.
Results:
2 out of 5 cases followed Cesarean section , 2 out of 5 cases followed hysterectomy and 1 out of 5 followed uterosacral ligament fixation . Mean operative time was 198 min , blood loss was <25ml for all patients. Mean hospital stay was 19 days with an immediate return to work on the first day after discharge . There were no major complication and all patient were continent at the 3 months follow-up with a satisfying voiding cystourethrogram.
Conclusion:
UVF including those caused by Cesarean sections can be treated safely and effectively by a standardized laparoscopic approach in a population with limited means and social structures.