Repair of Vesico-Vaginal Fistula Overview

This procedure involves repairing an abnormal connection between the urinary tract (usually the bladder) and the vagina. A fistula is the word used to describe a connection between two organ structures. The repair can range from simple to complex.

The Urinary Tract © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

Your doctor may do the following:

• Physical exam, blood and urine test, and imaging tests

• Discuss with you the type of anesthesia that will be used and the potential risks

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs

• Blood thinners (eg, warfarin , clopidogrel )

Other things to keep in mind prior to the procedure:

• Arrange for a ride home from the hospital.

• If instructed by your doctor, avoid food or drinks for 6-8 hours before the procedure.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV (a needle placed in your arm).

Description of the Procedure

You will be prepared for surgery. IVs will be placed in your arm or hand for medicines and fluids. The surgery can be done through the vagina or through an incision in the abdomen.

Transvaginal

Once you are asleep, the doctor will insert a catheter (tube) into the urethra. A speculum (used to hold the vagina open) will also be placed in the vagina. The doctor will locate the fistula. The walls of fistula will be cut away. The fistula will be closed with sutures. Special dressings will be placed in the vagina.

Transabdominal

A small incision will be made in the lower abdomen. Once the fistula is located, its lining will be cut and removed. The tissue will be manipulated so that there is no longer a connection between the urinary tract and the vagina. The vaginal wall and wall of the urinary tract will be repaired. The abdominal wall will be closed. Catheter tubes may be left in place after the procedure to help drain urine. The doctor may also place stents (a type of catheter) in the ureters (the tubes that carry urine from the kidneys to the bladder).

Immediately After Procedure

You may have a temporary catheter in your urethra when you wake up.

How Long Will It Take?

1- 3 hours or longer, depending on complexity

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Pain or soreness during recovery will be managed with pain medicine.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is:

• 1-2 days for a simple repair

• 3-5 days for a complex repair

Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

After the procedure, the hospital staff may do the following:

• Monitor you while you recover from the anesthesia.

• Help you gradually begin to eat and move around.

• Give you pain medicine.

• Take care of your catheter. The catheter will likely be in place for several weeks.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Take medicines to treat pain and bladder spasms and to reduce infection.

• Avoid lifting heavy objects and doing strenuous activity for several weeks.

• Drink plenty of fluids (eg, 8-10 glasses per day).

• Do not drive or have sex until your doctor says that it is safe to do so.

• Be sure to follow your doctor’s instructions.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org/

American Congress of Obstetricians and Gynecologists
http://www.acog.org/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index-eng.php/

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/

References:

Jatoi N, Jatoi N, Shaikh F, Ssirichand P. Key to successful vesico vaginal fistula repair: an experience of urogenital fistula surgeries and outcome at gynecological surgical camp 2005. Ayub Medical College website. Available at: http://www.ayubmed.edu.pk/JAMC/PAST/20-2/Nasreen.pdf . Accessed August 19, 2010.

Mayo Clinic. Vaginal fistulas. Mayo Clinic website. Available at: http://www.mayoclinic.org/vaginal-fistulas/ . Accessed August 19, 2010.

Milton S. Hershey Medical Center. Vesicovaginal fistula. Milton S. Hershey Medical Center website. Available at: http://www.hmc.psu.edu/healthinfo/uz/vesicovaginalfistula.htm . Updated October 31, 2006. Accessed August 19, 2010.

Ockrim JL. A tertiary experience of vesico-vaginal and urethra-vaginal fistula repair: factors predicting success. BJU Int.2009;103(8):1122-1126.

Oluseyun A, Akinfolarin A, Olabisi L. A review of clinical patterns and outcomes of vesico-vaginal fistula. J Natl Med.2009;101(6):593-595.

Rizvi S, Gupta R, Patel S, Trevidi A, Trevidi P, Modi P. Modified laparoscopic abdominal vesico-vaginal fistula repair. J Laparoendoscopic and Advanced Surg.2010;20(1):13-15.