WOFAPS 2025 8th World Congress of Pediatric Surgery

Sarra Chennouf, Aida el Gouacem, Hichem Choutri, Amina Bensebti, Zoubir Atrih

Boubnider University constantine3, Faculty of medecine, Department of pediatric surgery SMK Constantine

Background:
Congenital vesicovaginal fistula (VVF) is an extremely rare urogenital anomaly in pediatric patients, with few cases reported in the literature. It results from an embryological defect in the urogenital sinus or mesonephric duct development. Management requires a precise surgical technique that ensures complete closure while minimizing the risk of recurrence and preserving continence.

Case Presentation:
We report the case of an 8-year-old girl presenting with lifelong continuous urinary leakage since infancy, without any history of trauma, surgery, or infection. Physical examination and imaging—including ultrasound, voiding cystourethrogram, and cystoscopy—confirmed a congenital vesicovaginal fistula located at the posterior bladder wall, without any associated genitourinary anomalies.

Surgical Management:
The patient underwent laparoscopic transperitoneal fistula repair. Dissection was performed predominantly on the vaginal side, allowing precise identification and mobilization of the fistula tract. After complete excision of the tract, both bladder and vaginal walls were closed separately in two watertight layers using absorbable sutures. A peritoneal flap was interposed between the two suture lines to reduce the risk of recurrence. A transurethral Foley catheter and suprapubic catheter were left in place.

Outcome:
The postoperative course was uneventful. The catheters were removed on postoperative day 14. At 3- and 6-month follow-up, the patient remained fully continent, with normal voiding and no recurrence of leakage. Follow-up cystoscopy confirmed complete healing.

Conclusion:
Congenital vesicovaginal fistula is a rare but treatable condition in children. Laparoscopic repair with vaginal-side dissection and peritoneal interposition is a safe and effective approach, offering excellent visualization, minimal morbidity, and optimal long-term outcomes in pediatric patients.