A 44-year-old female who underwent total abdominal hysterectomy, left salpingo-oophorectomy, and right salpingectomy for a 10 cm leiomyoma developed a vesicovaginal fistula located adjacent to the left ureteral orifice post-operatively. Given the high risk of a ureteral injury when repairing a fistula in close proximity with the ureteral orifice, a transabdominal vesicovaginal repair combined with a non-transecting ureteroneocystostomy was done. As to the authors’ knowledge, this is the first time this combined technique has been performed in the Philippines.

Cystoscopy was performed to confirm the defect. Retrograde pyelography showed no ureteral fistula or obstruction. A midline incision was done and carried down to the peritoneal cavity. The bladder was identified and opened. The fistulous tract was excised transvesically. The vaginal septal defect was closed. An omental flap was mobilized and brought down to cover the fistula site. The ureter was then identified extravesically. A side-to-side non-transecting ureteroneocystostomy was performed to “create” a neo-orifice at the level of the bladder dome. This was done by performing a ventral ureterotomy at the level of the middle ureter along with a posterior cystotomy. No attempt was made to completely mobilize the distal ureter. The side to side anastomosis between the bladder and ureter was performed using interrupted vicryl 4-0 sutures. The bladder was then closed in two layers. Double J stents were placed bilaterally. Adequate bladder drainage was ensured. Total operative time was 4 hrs. The ureteroneocystostomy per se only took 1 hour.

One month postoperatively, the patient reported no more leakage. A repeat cystogram did not show the previously noted fistula. The patient was able to void freely without any signs of incontinence. A repeat cystoscopy 6 months postoperatively, showed a completely healed repair site. A retrograde pyelogram was performed at the ureteroneocystostomy site, revealing no leaks and confirming that the native ureter was patent. Stents were removed.

The non-transecting ureteroneocystostomy technique is a promising alternative for traditional transecting ureteral reimplantation, aiming to preserve the blood supply and potentially reduce recurrence rates of strictures, or in this case, provide an easier way to perform a prophylactic ureteral reimplantation to avoid any injury while performing a transvesical repair of a vesicovaginal fistula. Studies have shown successful outcomes with minimal complications, making it a feasible and effective approach over the standard transecting ureteronocystostomy. The reported success rates of 87.5% to 93.8% at short to medium-term follow-up indicate its potential as a novel management strategy for distal ureteral strictures and other case such as a supplementary management in vesicovaginal fistula repair. Further research and long-term follow-up are necessary to establish its widespread. adoption and refine its application in clinical practice. As to the authors’ knowledge, this is the first time this combined technique has been performed in the Philippines.