Vesicovaginal fistula is sometimes somewhat challenging in terms of diagnosis and precise identification of the orifice, calling for several tests to be performed, such as intravaginal tampon, cystoscopy, retrograde pyelography, vaginal examination, voiding cystourethography, and intravenous urography, which may worsen the problems of both patient and physician. There is no consensus about the best test to be performed as well as there is a debate regarding the best surgical technique. In 2003, a technique was reported using a device that permits simultaneous viewing on the same display (picture in picture) of two images called combined vaginoscopy-cystoscopy (CVC) during evaluation for vesicovaginal fistula.
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The presented article uses a simultaneous view provided by a cystoscope as a means of treatment and claims better visualization that could provide a more efficient result. It is a technical innovation, maybe simpler than CVC, with equipment available in most hospitals.
There are few results to report in this initial experience, however. There is a need to have a further comparison with a conventional approach—either a vaginal approach or, as some surgeons would have chosen, an abdominal approach—for supratrigonal fistula. Then we will know better the role of the proposed technique.
