Robotic ureterovaginal fistula repair: A surgical demonstration and case series

Ureterovaginal fistula (UVF) is an abnormal communication between the ureter and vagina. UVFs present with urinary leakage and complications include infections and emotional distress. While conservative management with ureteral stenting may be effective in select cases, surgical repair is often required for persistent fistulae. Here, we present a case series of patients undergoing robotic-assisted UVF repair and ureteral reimplantation. A retrospective chart review was performed on subjects undergoing robotic UVF repairs between 2010 and 2024. Descriptive statistics were collected and are represented as median and range. Eight patients underwent robotic-assisted UVF repair. The median age was 44 years (range: 32–66), and the median time to repair was 3 years. 7 patients underwent robotic repair, while 1 case was converted to open surgery. The median estimated blood loss was 75 mL, and the median hospital stay was 2 days. During the follow-up period (median 6.3 years), there was 1 fistula recurrence and 1 intra- (iliac vessel injury requiring repair) and 2 post-operative complications (sepsis, urine leak); these all occurred in 2 patients with prior pelvic radiation. The other 6 patients achieved successful robotic-assisted repair without fistula recurrence at their last follow-up appointment. Robotic-assisted ureteral reimplantation is a practical approach for UVF repair, offering advantages such as minimal blood loss, shorter hospitalization, and favorable long-term outcomes. Factors affecting successful repair include a history of pelvic radiation and the surgeon's experience in functional and reconstructive urology; surgical considerations include tissue interposition and distal ureter excision. Continued advancements in robotic surgery may further optimize management strategies.