Closure of Vesicovaginal Fistula; Transvesical and Vaginal Approach

Name of the Procedure:

• Common Name: Fistula Repair Surgery
• Medical Term: Closure of Vesicovaginal Fistula; Transvesical and Vaginal Approach

Summary

This surgical procedure involves closing an abnormal connection (fistula) between the bladder (vesico) and the vagina. It is performed using both the transvesical (through the bladder) and vaginal approaches to ensure effective closure and healing.

Purpose

The primary purpose of this procedure is to treat vesicovaginal fistulas, which can cause urine to leak uncontrollably from the bladder into the vagina. Successful closure of the fistula aims to restore normal urinary function and improve the patient's quality of life.

Indications

• Persistent leakage of urine through the vagina
• Recurrent urinary tract infections (UTIs)
• Irritation or infection of the vaginal tissues
• Confirmation of a vesicovaginal fistula through imaging or cystoscopy

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustments to current medications as advised by the surgeon, especially blood thinners
• Pre-operative diagnostic tests such as urine tests, blood tests, and imaging studies (e.g., cystoscopy or MRI)
• Bowel preparation may be required in some cases

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Access: An incision is made through the abdominal wall to access the bladder (transvesical approach), and another incision through the vaginal wall.
3. Identification: The fistula is identified and assessed from both the bladder and vaginal sides.
4. Dissection: Surrounding tissues are carefully dissected to expose the fistula tract.
5. Closure: The fistula is closed in layers using sutures, first from the bladder side and then the vaginal side.
6. Repair: In some cases, tissue grafts or flaps might be used to reinforce the repair.
7. Drainage: A catheter is placed in the bladder to ensure proper drainage during the healing process.
8. Completion: Incisions are closed, and the patient is moved to the recovery area.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Lead Surgeon specializing in Urology or Gynecology
• Surgical Assistant(s)
• Anesthesiologist
• Nursing Staff
• Operating Room Technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Damage to adjacent organs such as the ureters or bowel
• Fistula recurrence
• Urinary incontinence
• Anesthesia-related complications

Benefits

• Restoration of normal urinary function
• Resolution of symptoms such as urine leakage and recurrent infections
• Improved quality of life and sexual health

Recovery

• Hospital stay for 3 to 5 days post-surgery
• Catheter typically remains for 1 to 2 weeks
• Pain management through prescribed medications
• Restricted physical activity for 4 to 6 weeks
• Follow-up appointments for monitoring healing progress
• Avoidance of sexual intercourse for 6 weeks

Alternatives

• Conservative management with catheterization
• Other surgical approaches like laparoscopic or robotic-assisted repair
• Each alternative has its pros and cons which should be discussed with the healthcare provider

Patient Experience

• Mild to moderate pain expected post-operation, managed with pain relief medication
• Initial discomfort due to the catheter
• Gradual improvement in symptoms over several weeks
• Emotional support and counseling may help with coping and recovery

This markdown description provides a detailed overview of the procedure for medical personnel and patients alike, ensuring clarity and understanding of all aspects involved.