VESICO-VAGINAL-FISTULA REPAIR

General Information

DEFINITION-Repair of a vesico-vaginal fistula, an abnormal tract between the bladder and the vagina that usually results from tearing in childbirth or, rarely, a complication of cervical cancer.

BODY PARTS INVOLVED-Vagina and bladder.

REASONS FOR SURGERY

• Control of urine flow from the bladder.
• Prevention of vaginal and urinary-tract infections.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking; stress.
• Poor nutrition.
• Recent or chronic illness.
• Alcoholism.
• Previous pelvic surgery.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES-Obstetrician-gynecologist, urologist or general surgeon.

WHERE PERFORMED-Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; pelvic exam; cystoscopy (See Glossary) with possible biopsy (sometimes).
• After surgery: Blood studies; laboratory examination of removed tissue.

ANESTHESIA

• Spinal anesthesia by injection.
• General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• A speculum is used to hold the vagina open.
• Scar tissue around the fistula is cut free and removed. Healthy tissue is interposed between the 2 layers of the fistula.
• The bladder wall and vaginal wall are closed with sutures that will be absorbed by the body.
• The bladder is filled with sterile water to search for leaks. If leaks exist, further repairs are made. If no leaks are found, a catheter is placed in the bladder.
• The catheter usually can be removed about 5 to 7 days after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Urinary-tract infection.
• Continued urine leakage through fistula.

AVERAGE HOSPITAL STAY-6 days.

PROBABLE OUTCOME-Expect complete healing without complications. Allow about 6 weeks for recovery from surgery.

Postoperative Care

† Use an electric heating pad, a heat lamp or a warm compress to relieve surgical--

wound pain.

• Take warm baths several times a day to relieve discomfort. > Move and elevate legs often while resting in bed to decrease the likelihood of deep-vein blood clots.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

† To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 weeks after surgery. > Resume driving 3 weeks after returning home. > Resume sexual relations when your doctor determines that healing is complete.

DIET--Your doctor will prescribe a diet.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting or constipation.
• You develop urinary frequency and stinging or burning on urination.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.