Name of the Procedure:

Closure of Urethrovaginal Fistula

Summary

Closure of urethrovaginal fistula is a surgical procedure aimed at repairing a connection between the urethra and the vagina. This condition, known as a urethrovaginal fistula, often leads to continuous urinary leakage and other complications. The surgery involves closing the abnormal fistulous tract to restore normal anatomy and function.

Purpose

This procedure addresses the presence of an abnormal connection, or fistula, between the urethra and the vagina. The primary goal is to stop the involuntary leakage of urine and to restore the patient's normal urinary function and quality of life.

Indications

• Continuous urinary leakage despite normal urination.
• Discomfort or pain in the vaginal area.
• Frequent urinary tract infections (UTIs).
• History of trauma, surgery, or radiation therapy that may have caused the fistula.
• Suitable for patients who have been assessed and diagnosed with a urethrovaginal fistula.

Preparation

• Fasting for a specified period before surgery.
• Adjustment or discontinuation of certain medications as advised by the healthcare provider.
• Completing certain diagnostic tests like cystoscopy, MRI, or CT scans to locate and assess the fistula.
• Preoperative consultation with the surgical team for specific instructions and expectations.

Procedure Description

1. The patient is given general anesthesia to ensure they are completely unconscious and pain-free during surgery.
2. A surgical incision is made to access the fistula site.
3. The tissue around the fistula is carefully dissected to separate the urethra and the vagina.
4. The fistula is closed using sutures, sometimes involving the use of grafts to reinforce the closure.
5. The surgical site is examined for proper closure and integrity.
6. The incision is closed and dressed appropriately.

The procedure employs tools such as surgical scalpels, sutures, and sometimes graft materials.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the fistula.

Setting

The procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (Urologist or Gynecologist specialized in pelvic repair)
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Recurrence of the fistula.
• Urinary incontinence.
• Damage to surrounding structures such as the bladder or urethra.
• Postoperative pain and discomfort.

Benefits

• Resolution of urinary leakage.
• Improved quality of life.
• Decrease in recurrent urinary infections.
• Restoration of normal anatomy and function. Benefits are usually realized within a few weeks after surgery, following recovery.

Recovery

• Pain management with prescribed medications.
• Instructions for wound care and hygiene.
• Avoidance of strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments to monitor healing and ensure no recurrence of the fistula.
• Gradual return to normal activities as advised by the healthcare provider. Full recovery typically takes 4 to 6 weeks.

Alternatives

• Conservative management with catheters to divert urine away from the fistula.
• Use of fibrin glue to close small fistulas.
• Pharmacological treatment to manage symptoms. The surgical closure offers a more definitive solution compared to conservative options but comes with higher risks and longer recovery time.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel any discomfort. Post-procedure, the patient may experience pain and tenderness at the surgical site, manageable with medications and rest. Patients are advised to follow care instructions carefully to promote healing and avoid complications.