Name of the Procedure:

Closure of Vesicouterine Fistula with Hysterectomy

Summary

This surgical procedure involves closing a hole (fistula) between the bladder (vesico-) and the uterus (uterine) and removing the uterus (hysterectomy). This surgery is usually needed when less invasive treatments have not been effective.

Purpose

This procedure addresses a vesicouterine fistula, which is an abnormal connection between the bladder and the uterus. The main goals are to remove the fistula, resolve symptoms like urinary incontinence and infections, and remove any tissue damage that can't be repaired.

Indications

• Persistent urinary incontinence
• Frequent urinary tract infections
• Pain or discomfort in the pelvic region
• Diagnosed vesicouterine fistula via imaging or other diagnostic tests
• Previous attempts at less invasive treatments that have failed

Preparation

• Fasting for at least 8 hours prior to surgery
• Discontinuation or adjustment of certain medications as advised by the surgeon
• Pre-operative blood tests, imaging studies, and possibly a cystoscopy (bladder examination)
• Bowel preparation may be required

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: An incision is made in the abdominal wall to access the pelvic organs.
3. Separation: The bladder and the uterus are carefully separated from each other.
4. Closure of Fistula: The fistula (abnormal connection) is identified and sutured closed.
5. Hysterectomy: The uterus is surgically removed.
6. Inspection: The area is inspected for any damage or leakage.
7. Closure: The abdominal incision is closed in layers.

Specialized surgical instruments are used, and the procedure requires careful coordination with intraoperative imaging tools.

Duration

The procedure typically takes 3-4 hours, depending on the complexity of the fistula and the patient's overall condition.

Setting

This surgery is performed in a hospital operating room due to the complexity and need for a sterile environment.

Personnel

• Primary Surgeon (usually a urogynecologist or a specialist in pelvic floor disorders)
• Surgical Assistant
• Anesthesiologist
• Operating Room Nurses
• Scrub Technician

Risks and Complications

• Blood loss and need for transfusion
• Infection at the surgical site or within the pelvic cavity
• Injury to nearby organs (bladder, intestines)
• Anesthesia-related complications
• Blood clots
• Recurrence of the fistula

Benefits

• Relief from symptoms like urinary incontinence and pelvic pain
• Reduced risk of ongoing or recurrent infections
• Improved quality of life

Benefits are usually noticed soon after recovery from surgery, although full recovery might take several weeks.

Recovery

• Hospital stay for 3-5 days post-surgery
• Pain management with prescribed medications
• Avoid heavy lifting and strenuous activities for at least 6 weeks
• Follow-up visits with the surgeon for wound checks and to monitor healing
• Pelvic rest (no sexual intercourse) for a defined period

Alternatives

• Conservative management with continuous bladder drainage
• Less invasive surgical options if the fistula is small and easily accessible
• Pros of alternatives: less invasive, shorter recovery time
• Cons of alternatives: high recurrence rates, less effective for severe cases

Patient Experience

• The patient will be asleep under general anesthesia during the procedure.
• Post-operatively, patients might experience pain and discomfort in the pelvic and abdominal area.
• Pain will be managed with medications.
• Urinary catheters may be used temporarily to allow healing.
• Gradual return to normal activities as advised by the healthcare team.