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Repair of Vesico-Vaginal Fistula

  • Definition

    A fistula is an abnormal connection between two organs. In this case, the fistula connects an organ in the urinary tract (usually the bladder) with the vagina.
    The Urinary Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.
  • Reasons for Procedure

    This procedure is done to repair the abnormal connection between the 2 organs. Fistulas may be caused by:
  • Possible Complications

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Urinary tract infection or other infections
    • Irritation or inflammation of the vulva (the opening of the vagina)
    • Injury to bladder, vagina, or urethra (the tube that carries urine outside of the body from the bladder)
    • Bleeding
    • Adverse reaction to anesthesia
    Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
    • Smoking
    • Drinking
    • Chronic disease such as diabetes or obesity
    The following may also increase the risk of complications:
    • Taking blood-thinning medications
    • Having a fistula that is large or complex
  • What to Expect

    Prior to Procedure
    Your doctor may:
    • Do a physical exam
    • Order blood and urine tests
    • Order imaging tests
    • Do a cystoscopy
    • Talk to you about the type of anesthesia that will be used and the potential risks
    Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
    Other things to keep in mind prior to the procedure:
    • Arrange for a ride home from the hospital.
    • If instructed by your doctor, avoid food or drinks for 6-8 hours before the procedure.
    Anesthesia
    General anesthesia will keep you asleep during the procedure.
    Description of the Procedure
    The surgery can be done through the vagina or through an incision in the abdomen. You may also have a cystoscopy done during the procedure.
    Transvaginal
    The doctor will insert a catheter (tube) into the urethra. A speculum will also be used to open the the vagina. The doctor will locate the fistula. The walls of fistula will be cut away. The fistula will be closed with sutures. Special dressings will be placed in the vagina.
    Transabdominal
    A small incision will be made in the lower abdomen. Once the fistula is located, its lining will be cut and removed. The tissue will be manipulated so that there is no longer a connection between the urinary tract and the vagina. The vaginal wall and wall of the urinary tract will be repaired. The abdominal wall will be closed. Catheter tubes may be left in place after the procedure to help drain urine. The doctor may also place stents (a type of catheter) in the ureters.
    Immediately After Procedure
    You may have a temporary catheter in your urethra when you wake up.
    How Long Will It Take?
    1-3 hours or longer (depending on how complex the surgery is)
    How Much Will It Hurt?
    Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
    Average Hospital Stay
    This procedure is done in a hospital setting. The usual length of stay is:
    • 1-2 days for a simple repair
    • 3-5 days for a complex repair
    Post-procedure Care
    At the Hospital
    After the procedure, the hospital staff may do the following:
    • Monitor you while you recover from the anesthesia.
    • Help you gradually begin to eat and move around.
    • Give you pain medication.
    • Take care of your catheter. The catheter will likely be in place for several weeks.
    During your stay, the hospital staff will take steps to reduce your chance of infection such as:
    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered
    There are also steps you can take to reduce your chances of infection such as:
    • Washing your hands often and reminding visitors and healthcare providers to do the same
    • Reminding your healthcare providers to wear gloves or masks
    • Not allowing others to touch your incisions
    At Home
    You may have to restrict your activities during your recovery until you have permission from your doctor. You may be given specific exercises to do at home to promote healing and maintain strength. Pain can be managed with medications. Avoid sexual intercourse until your doctor says it is okay.
  • Call Your Doctor

    It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
    • Increasing pressure or pain
    • Redness, soreness, bleeding, or discharge at or around the incision site
    • Changes in frequency, odor, appearance, or amount of urine
    • Inability to urinate
    • Signs of infection, including fever or chills
    • Excess blood in urine
    If you think you have an emergency, call for medical help right away.
  • RESOURCES

    Family Doctor—American Academy of Family Physicians http://www.familydoctor.org

    American Congress of Obstetricians and Gynecologists http://www.acog.org

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

    References

    Jatoi N, Jatoi N, Shaikh F, Ssirichand P. Key to successful vesico-vaginal fistula repair: an experience of urogenital fistula surgeries and outcome at gynecological surgical camp 2005. Ayub Medical College website. Available at: http://www.ayubmed.edu.pk/JAMC/PAST/20-2/Nasreen.pdf . Accessed September 26, 2014.

    Rizvi S, Gupta R, Patel S, Trevidi A, Trevidi P, Modi P. Modified laparoscopic abdominal vesico-vaginal fistula repair. J Laparoendoscopic and Advanced Surg. 2010;20(1):13-15.

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