Closure of vesicovaginal fistula, abdominal approach
CPT4 code
Name of the Procedure:
Closure of Vesicovaginal Fistula, Abdominal Approach
Summary
A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, leading to continuous urinary leakage. The closure of this fistula using an abdominal approach entails surgically accessing the fistula through the abdomen to repair the tissue and close the hole.
Purpose
This procedure addresses vesicovaginal fistulas, typically resulting from surgical complications, childbirth injuries, or pelvic radiation. The goal is to eliminate the abnormal passage between the bladder and vagina, thus stopping urinary leakage and improving the patient's quality of life.
Indications
- Continuous urinary leakage from the vagina
- Recurrent urinary tract infections
- Discomfort and irritation in the vaginal area
- Confirmed diagnosis of vesicovaginal fistula through imaging studies or clinical examination
Preparation
- Fasting for at least 8 hours before the procedure
- Discontinuation of certain medications as advised by the healthcare provider
- Preoperative imaging assessments like a cystogram or CT scan to locate the fistula
- Routine blood tests and urine analysis
Procedure Description
- The patient is administered general anesthesia to ensure they are asleep and pain-free during the surgery.
- A surgical incision is made in the lower abdominal area.
- The bladder and vagina are carefully exposed to locate the fistula.
- The edges of the fistula are trimmed to healthy tissue.
- The bladder and vaginal tissues are then stitched separately to close the fistula.
- A catheter is placed in the bladder to allow urine to drain while the tissues heal.
- The abdominal incision is closed with sutures or staples.
Duration
The procedure typically takes about 2 to 4 hours, depending on the complexity and location of the fistula.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Surgeon
- Surgical assistants
- Anesthesiologist
- Operating room nurses
Risks and Complications
- Bleeding
- Infection
- Injury to surrounding organs (bowel, ureters)
- Recurrence of the fistula
- Anesthesia-related complications
Benefits
- Elimination of urinary leakage
- Reduction in the risk of recurrent infections
- Improvement in overall quality of life and comfort
Benefits usually become noticeable within weeks to months as the tissues heal and normal urinary function is restored.
Recovery
- Hospital stay of approximately 3 to 5 days post-surgery
- The bladder catheter is typically kept in place for 1 to 2 weeks.
- Limited physical activity for about 6 weeks
- Follow-up appointments to monitor healing
- Pain management with prescribed medications
Alternatives
- Conservative management with continuous drainage (e.g., catheterization)
- Transvaginal surgical approach
- Endoscopic procedures for smaller fistulas
Each alternative has its pros and cons; for example, conservative management might avoid surgery initially but may not be a permanent solution, while a transvaginal approach could be less invasive but not suitable for all fistula locations.
Patient Experience
- The patient will be under general anesthesia and feel no pain during the surgery.
- Postoperative discomfort will be managed with pain medications.
- Potential temporary difficulty with mobility and daily activities.
- Continuous drainage via catheter which might cause temporary inconvenience.