Repair of a urinary vaginal fistula

What is this?

Surgical closure of an abnormal connection (resulting in a urinary leak) between the vagina and the bladder or ureter

What alternatives are there?

Urine diversion by bladder catheter/nephrostomy, ileal conduit urinary diversion, observation, very occasionally closure of the vagina (colpocleisis)

What to expect before procedure

A pre-clerking appointment will also be sent to you to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. You will come into hospital on the day before surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer, your named nurse and possibly a Urology Nurse Specialist. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. If your surgeon has decided to close a bladder fistula from below, the procedure will be performed entirely through the vagina, following which a pack is usually left in place in the vagina. Usually, an abdominal approach is necessary and the procedure will be performed through either a vertical or a transverse incision in your lower abdomen. The fistula is dissected out and the connection between the urinary tract and the vagina divided. It is usual to position part of the fatty envelope from inside the abdomen (the omentum) to prevent the fistula from recurring.

After the procedure

The average stay in hospital will last approximately 10-14 days. Two catheters will probably be placed in the bladder for up to two to three weeks, one via the urethra and one (suprapubic catheter) via a small incision in the skin over the bladder. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach. After your operation, you may be in the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm. You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation. It will, however, take at least 6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.

Potential side effects