Neobladder-vaginal fistulas following orthotopic ileocystoplasty

Abstract

Two clinical cases of neobladder–vaginal fistula (NVF), a rare complication of orthotopic cystoplasty, are presented. In a 42‑year‑old woman who had previously undergone open radical cystectomy with orthotopic ileal neobladder, the fistula was successfully treated by fistulorrhaphy at the first attempt. In a 63‑year‑old woman after robot‑assisted cystoplasty, NVF recurred two months after the initial repair; during re‑operation, the reservoir defect was sealed with biological glue, but the patient subsequently developed urinary peritonitis. This complication was managed laparoscopically by abdominal sanitation and drainage, resulting in spontaneous closure of the reservoir wall defect. On long‑term follow‑up, both patients achieved restoration of spontaneous voiding without urinary incontinence. The discussion addresses risk factors for NVF, including impaired vascularisation and intraoperative injury to the anterior vaginal wall, overlapping suture lines, post‑radiation changes, and other local tissue‑compromising conditions. Surgical options for NVF correction, primarily transvaginal and transabdominal approaches, are described with an emphasis on careful tissue handling and multilayer closure to ensure watertight sealing of the neobladder. The report underscores that NVFs are amenable to repair but highlights the importance of recognising the risk of intraperitoneal urine leakage in the setting of reservoir dehiscence and planning prompt intervention accordingly.