Name of the Procedure:

Closure of Urethrovaginal Fistula with Bulbocavernosus Transplant

Summary

This surgical procedure involves closing an abnormal connection between the urethra and vagina, utilizing a piece of muscle known as the bulbocavernosus. The surgery aims to restore normal urinary and reproductive function.

Purpose

The purpose of this procedure is to correct a urethrovaginal fistula, which can cause urine leakage into the vagina, leading to discomfort, infection, and social distress. The goal is to effectively close the fistula and use the bulbocavernosus muscle to reinforce the repair, promoting tissue healing and preventing recurrence.

Indications

• Persistent urinary incontinence due to urethrovaginal fistula
• Recurrent urinary tract infections
• Vaginal irritation or discharge caused by urine leakage
• Patients who have not responded to conservative treatments

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications may be necessary, especially blood thinners.
• Preoperative diagnostic tests could include imaging studies like a cystoscopy or MRI to assess the fistula's location and severity.
• Patients will undergo a preoperative medical evaluation to ensure they are healthy enough for surgery.

Procedure Description

1. Anesthesia: The procedure is usually done under general anesthesia.
2. Incision and Exposure: A surgical incision is made to access the fistula. The area is carefully exposed.
3. Closure of Fistula: The fistula is meticulously closed with sutures.
4. Bulbocavernosus Transplant: A segment of the bulbocavernosus muscle is harvested and transplanted to reinforce the repair area.
5. Final Steps: The surgical site is examined for any leaks, and the incision is closed in layers.

Duration

The procedure typically takes about 2-4 hours but can vary depending on the complexity of the fistula and patient anatomy.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Primary Surgeon (usually a urologist or gynecologist)
• Surgical assistants
• Scrub nurse
• Anesthesiologist
• Circulating nurse

Risks and Complications

• Infection
• Bleeding
• Recurrence of the fistula
• Pain at the surgical site
• Adverse reactions to anesthesia
• Urinary retention or incontinence

Benefits

• Resolution of urine leakage and associated symptoms
• Improved quality of life
• Reduced risk of recurrent infections
• Enhanced vaginal and urinary function

Recovery

• Hospital stay for a few days post-procedure for monitoring
• Pain management with prescribed medications
• Catheter may be placed temporarily to ensure proper urinary drainage
• Avoid heavy lifting and strenuous activities for 4-6 weeks
• Follow-up appointments to assess healing and remove the catheter

Alternatives

• Conservative management with catheters or pessaries
• Other surgical options like direct fistula repair without muscle transplant
• Pros and cons: Conservative management may be less invasive but less effective, while simpler surgical repairs may not provide the same reinforcement as the muscle transplant

Patient Experience

Patients may experience discomfort and pain post-surgery, managed with medications. They can expect some initial difficulty with urination and will need to adapt to using a catheter temporarily. Over time, most patients regain normal urinary function and relief from pre-operative symptoms.