A Vesicovaginal Fistula Repair procedure involves the repair of the vesicovaginal fistula in women in order to close the fistula, without encroaching on the bladder.
A vesicovaginal fistula is an abnormal connection of the urinary bladder and the vagina. This results in passage of urine through the vagina. It generally occurs due to trauma caused by pelvic surgery advanced pelvic cancer radiation therapy for treatment of pelvic cancer or trauma (other factors).
The Vesicovaginal Fistula Repair procedure is performed to control urine flow from the bladder, as well as to prevent any vaginal or urinary infections.
How a vesicovaginal fistula repair surgical procedure is performed?
- The Vesicovaginal Fistula Repair procedure can be performed in two ways - using an abdominal approach or a vaginal approach. The vaginal approach is generally preferred as it is less invasive (no laparotomy)
- Once anaesthesia is applied, a speculum is used to hold the vagina open. The scar tissue around the fistula is cut free and removed. The healthy tissue is interposed between the two layers of the fistula
- The bladder and vaginal wall are closed with sutures, which will be absorbed by the body
- The bladder is then filled with sterile water, to search for any leaks. If leaks exist, further repairs are made. If no leaks are found, then a catheter is placed in the bladder
- The urine that is present in the system is acidified to prevent the formation of any precipitations.
The procedure can be performed using a laparoscopy as well. The procedure is generally performed by an obstetrician-gynaecologist
, or a general surgeon
. The procedure to repair a vesicovaginal fistula usually takes between 2-6 hours to be completed.
Preparations needed before a vesicovaginal fistula repair surgical procedure
Diagnostic lab tests needed before vesicovaginal fistula repair surgical procedure
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally, local anaesthesia is not used however, do inform the physician if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
Prior to a Vesicovaginal Fistula Repair procedure, the patient may need to undergo certain tests, such as:
Risks and complications during vesicovaginal fistula repair surgical procedure
The possible risks or complications that may arise during the surgery are:
Risks and complications after vesicovaginal fistula repair surgical procedure
Post-operative care needed after a vesicovaginal fistula repair surgical procedure
- Excessive bleeding
- Surgical wound infection
- Urinary tract infection
- Continued urine leakage through the fistula
- Risks of abdominal and pelvic adhesions (if abdominal approach is used)
- Risks of dyspareunia and tenderness (if vaginal approach is used)
- Reduced vaginal length and calibre (if vaginal approach is used)
At home, the following post-operative care is recommended after a vesicovaginal fistula repair procedure:
- Avoid all activities that are physically strenuous after the surgery, for a period of time, as advised by your healthcare provider
- Be regular in taking the antibiotics and pain killers, as prescribed by the physician
- Take stool softeners to prevent constipation, under advice by the physician