Platelet-Rich Plasma as Adjuvant Therapy for Recurrent Vesicovaginal Fistula: A Prospective Case Series

Vesicovaginal fistula (VVF) is the nonphysiological communication between the bladder and vagina, and surgical closure is the gold treatment standard. Despite that successful closure occurs in around 85% of patients after the first repair, recurrence remains a highly distressing complication for patients and surgeons. The aim of our study was to evaluate the efficacy of a platelet-rich plasma (PRP) injection as a supportive treatment in the surgical repair of recurrent VVF. Between January 2018 and July 2019, 16 patients with recurrent VVF were injected with PRP in a tertiary gynecological department. Subsequently, a surgical Latzko procedure for VVF closure was scheduled 6–8 weeks after the PRP injection allowing proper neovascularization and remodeling of surrounding tissues. Patients were considered cured if no leakage was observed after surgery and negative dye test results were indicated at follow-up. All patients who were examined therein remained dry. To the best of our knowledge, this is the first study aiming to assess PRP injections as a supporting treatment prior to surgical procedure for recurrent VVF. Preliminary results are encouraging, and we incorporated this method in our clinical practice. Further reports on a larger group will follow.

Entrapped Urinary Calculi in Iatrogenically Created Vaginal Pocket During Robotic Repair of Vesicovaginal Fistula

Primary vaginal calculi exist as an extremely rare topic discussed only through a handful of case reports. Based on the cases studied, it was reported that they have an association with urethral diverticulum, urogenital sinus anomalies, urogenital fistula or with utilization of transvaginal urethral slings. We present a case of an incidental finding of multiple vaginal calculi impacted in the proximal vagina in an iatrogenically created pocket after a failed Latzko procedure which were later discovered during a robotically assisted laparoscopic vesicovaginal fistula (VVF) repair by the extravesical approach. This is the first reported incident of multiple vaginal calculi associated with iatrogenically created intravaginal pocket after Latzko procedure.