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Repair of Vesico-Vaginal Fistula

Definition

A vesico-vaginal fistula is an abnormal connection between the urinary tract and the vagina. The repair will separate the organs.

The Urinary Tract

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Reasons for Procedure

This type of fistula can cause uncontrolled urine leakage through the vagina. It can also be painful and increase the risk of infections. Surgery will close the fistula to stop symptoms.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems such as:

  • 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

The risk of problems may be higher in those who:

  • Smoke
  • Drink
  • Have chronic disease such as diabetes or obesity

The risk of problems with a fistula repair may also be higher with:

  • Blood-thinning medicines
  • Large or complex fistulas

What to Expect

Prior to Procedure

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to 1 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 to 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 belly. A scope may also be passed through the urethra into the bladder.

Transvaginal

A small tube will be inserted into the urethra. A speculum will also be used to open the vagina. The doctor will locate the fistula. The walls of fistula will be cut away. The area will then be closed with sutures. Special dressings may be placed in the vagina.

Transabdominal

A small incision will be made in the lower belly. The doctor will locate the fistula. The fistula lining will be cut and removed. The tissue will be moved to disconnect the urinary tract and vagina. The vaginal wall and wall of the urinary tract will then be closed. The wall of the belly will be closed.

Immediately After Procedure

A tube may be in the urethra to drain the bladder. It will be moved some time after you wake up.

How Long Will It Take?

1 to 3 hours or longer if the surgery is more complicated

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medicines.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is:

  • 1 to 2 days for a simple repair
  • 3 to 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 medicine.
  • Take care of your catheter. The catheter will likely be in place for several weeks.

At Home

Some activity will need to be avoided until the area has healed.

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:

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

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

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca/en/health-canada.html

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

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.

Last reviewed September 2020 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC  Last Updated: 8/7/2020