• Repair of Vesico-Vaginal Fistula

    Definition

    A fistula is a connection between two organs. This procedure is done to repair a fistula between the urinary tract (usually the bladder) and the vagina.
    The Urinary Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    A vesico-vaginal fistula repair is done in women with a fistula, which may be caused by:

    Possible Complications

    Complications are rare. But, no procedure is completely free of risk. If you are planning to have vesico-vaginal fistula repair, your doctor will review a list of possible complications, which may include:
    • Urinary tract infection or other infections
    • Irritation or inflammation of the vulva (the opening of the vagina)
    • Injury to bladder, vagina, or urethra (the tube that carries urine outside of the body from the bladder)
    • Bleeding
    • Adverse reaction to anesthesia (eg, low blood pressure, wheezing)
    Factors that may increase the risk of complications include:
    • Smoking
    • Being obese
    • Taking blood-thinning medicines
    • Having a fistula that is large or complex
    Discuss these risks with your doctor before the procedure.

    What to Expect

    Prior to Procedure

    Your doctor may:
    • Do a physical exam
    • Order blood and urine tests
    • Order imaging tests
    • Do a cystoscopy (an examination of the bladder using a special lighted scope)
    • Talk to you about 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 and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Anti-platelet drugs, such as clopidogrel (Plavix)
    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 will be 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. You may also have a cystoscopy done during the procedure.
    Transvaginal
    The doctor will insert a catheter (tube) into the urethra. A speculum will also be used to open the 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.

    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 how complex the surgery is)

    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

    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 have sexual intercouse until your doctor tells you that it is safe to do so.
    • Ask your doctor when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Increasing pressure or pain
    • Redness, soreness, bleeding, or discharge at or around the incision site
    • Changes in frequency, odor, appearance, or amount of urine
    • Inability to urinate
    • Signs of infection, including fever or chills
    • Excess blood in urine (Small amounts are normal.)
    If you think you have an emergency, call for medical help right away.

    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%5Fe.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.

    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.

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