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Closure of vesicouterine fistula

CPT4 code

Name of the Procedure:

Closure of Vesicouterine Fistula

Summary

A vesicouterine fistula is an abnormal connection between the bladder and the uterus. Closure of a vesicouterine fistula is a surgical procedure aimed at repairing this connection to restore normal function and prevent complications.

Purpose

The procedure addresses the presence of a vesicouterine fistula, which can cause issues such as continuous urine leakage into the uterus and recurrent urinary tract infections. The goals are to repair the abnormal connection, restore normal bladder and uterine function, and improve the patient's quality of life.

Indications

  • Continuous urine leakage from the vagina, especially post childbirth or surgery
  • Recurrent urinary tract infections
  • Pelvic pain or discomfort
  • Diagnosed vesicouterine fistula via imaging or cystoscopy

Preparation

  • Patients may need to fast for a certain period before the procedure.
  • Adjustments to medications may be required; patients should inform their doctor of all medications they are taking.
  • Preoperative imaging tests such as cystoscopy, MRI, or CT scan to confirm the fistula's location and size.

Procedure Description

  1. The patient is administered general anesthesia.
  2. A catheter is placed in the bladder to drain urine.
  3. An incision is made to access the fistula, either through the abdomen or vagina.
  4. The fistula is identified and carefully separated from surrounding tissues.
  5. The bladder and uterus are individually repaired using sutures.
  6. A tissue graft may be used to reinforce the repair area.
  7. The incision is closed, and a catheter is left in place to allow healing.

Duration

The procedure typically takes about 2-4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

  • Surgeon specializing in urology or gynecology
  • Anesthesiologist
  • Nursing staff
  • Surgical assistants

Risks and Complications

  • Infection at the surgical site
  • Bladder or uterine injury
  • Bleeding
  • Recurrence of the fistula
  • Anesthesia-related risks
  • Potential need for additional surgery if complications arise

Benefits

  • Resolution of urine leakage
  • Reduction in urinary tract infections
  • Improvement in pelvic pain and overall quality of life
  • Restoration of normal bladder and uterine function

Recovery

  • Postoperative monitoring in the hospital for a few days
  • Pain management with prescribed medications
  • Instructions on catheter care if it remains in place temporarily
  • Avoid heavy lifting and strenuous activity for several weeks
  • Follow-up appointments to check the healing process and remove the catheter, if necessary.

Alternatives

  • Conservative management, such as catheter use, which may not be as effective long-term.
  • Other surgical techniques tailored to the specific type and location of the fistula.
  • Each alternative has its pros and cons, such as varying success rates and recovery times, that should be discussed with a healthcare provider.

Patient Experience

The patient will be under general anesthesia during the procedure, so they will not feel any pain. Post-procedure, there might be some discomfort or pain at the surgical site, which can be managed with pain medication. The patient might experience some urinary symptoms as the bladder heals and should follow specific instructions for a smoother recovery. Regular follow-up visits will be necessary to ensure proper healing.

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