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A. Surgical closure of an abnormal communication (resulting in a urinary leak) between the vagina and the bladder or ureter.
A. the alternatives include:
A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.
You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six 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.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. 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.
Vaginal approach: 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.
Occasionally, if the fistula is very close to the ureteric orifice or orifices (the exit of the ureter carrying urine from your kidney to your bladder), your surgeon may need to re-implant the ureter or both ureters elsewhere into the bladder. Usually, as part of the procedure, your surgeon will place stents within the ureters and these maybe in place at the end of surgery.
Abdominal approach: 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.
A. 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.
We will start you on fluid drinks and food as soon as possible.
Two catheters will probably be placed in the bladder for up 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. The average stay in hospital will last approximately less than seven days.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
Occasional (between one in 10 and one in 50)
Rare (less than one in 50)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
You will require pain-killing tablets at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile.
You may go home with one or both catheters still in place, and have a planned return to hospital for these to be removed. If so, you or your carers will be taught how to look after the catheters and the drainage systems for them.
You should avoid driving for at least six weeks, and it may be longer before this is possible.
If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity.
Heavy lifting should be avoided for six weeks.
Sexual intercourse should be avoided for at least a month.
You may see blood in the urine or vaginal discharge for up to a month after surgery.
A. If you go home with catheters, you or your carers should check regularly to ensure that urine is draining via the catheters, which confirms that the catheters have not blocked. If the catheters both block this can put pressure on the suture line in the bladder, and so the catheters would need to be flushed and unblocked very promptly.
Consult you urologist immediately if the catheter gets blocked.
A. Usually, three to four weeks after surgery, you will be have an X ray dye test (a cystogram) to check that the bladder has healed.
At a later date, you may also have to re-attend hospital to have the ureteric stents removed.
A follow up outpatient appointment will be arranged at about six to eight weeks after surgery.