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Vesicovaginal Fistula Repair

Last updated Sept. 4, 2018

Approved by: Krish Tangella MD, MBA, FCAP

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A Vesicovaginal Fistula Repair procedure involves the repair of the vesicovaginal fistula in women; in order to close the fistula, without encroaching on the bladder.


Background Information:

What are the other Names for the Procedure?

  • Repair of Vesicovaginal Fistula
  • Repair of VVF
  • VVF Repair

What is Vesicovaginal Fistula Repair surgical procedure?

A Vesicovaginal Fistula Repair procedure involves the repair of the vesicovaginal fistula in women; in order to close the fistula, without encroaching on the bladder.

Vesicovaginal fistula (VVF):

  • A fistula is an abnormal connection between an organ and another structure
  • A vesicovaginal fistula is an abnormal connection of the urinary bladder and the vagina. This results in passage of urine through the vagina
  • It generally occurs due to:
    • Trauma caused by pelvic surgery
    • Advanced pelvic cancer
    • Radiation therapy for treatment of pelvic cancer      
    • Trauma (other reasons)

What part of the Body does the Procedure involve?

A Vesicovaginal Fistula Repair procedure involves the urinary bladder and the vagina.

Why is the Vesicovaginal Fistula Repair surgical procedure Performed?

The Vesicovaginal Fistula Repair procedure is performed to control urine flow from the bladder, as well as to prevent any vaginal or urinary infections.

What are some Alternative Choices for the Procedure?

There are no particular alternatives to this surgical procedure.

What are the Recent Advances in the Procedure?

Various non-invasive methods are being developed, to carry out the Repair of Vesicovaginal Fistula. Laparoscopy is being used to perform this procedure, with minimal invasion and blood loss.

What is the Cost of performing the Vesicovaginal Fistula Repair surgical procedure?

The cost of Vesicovaginal Fistula Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Vesicovaginal Fistula Repair procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/11VesicovaginalFistulaRepair/chap2sec11.html

http://www.miklosandmoore.com/lap_proc13_old.php

Prior to Vesicovaginal Fistula Repair surgical procedure:

How is the Vesicovaginal Fistula Repair surgical procedure Performed?

  • The Vesicovaginal Fistula Repair procedure can be performed in two ways - using an abdominal approach or a vaginal approach. The vaginal approach is generally preferred as it is less invasive (no laparotomy)
  • Once anesthesia is applied, a speculum is used to hold the vagina open. The scar tissue around the fistula is cut free and removed. The healthy tissue is interposed between the two layers of the fistula
  • The bladder and vaginal wall are closed with sutures, which will be absorbed by the body
  • The bladder is then filled with sterile water, to search for any leaks. If leaks exist, further repairs are made. If no leaks are found, then a catheter is placed in the bladder
  • The urine that is present in the system is acidified to prevent the formation of any precipitations. The procedure can be performed using a laparoscopy as well

Where is the Procedure Performed?

A Vesicovaginal Fistula Repair procedure is generally performed in the surgical facility of a hospital.

Who Performs the Procedure?

The procedure is generally performed by an obstetrician-gynecologist, an urologist, or a general surgeon.

How long will the Procedure take?

The procedure to repair a VVF, usually takes between 2-6 hours to be completed.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally, local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Vesicovaginal Fistula Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Vesicovaginal Fistula Repair surgical procedure?

Prior to a Vesicovaginal Fistula Repair procedure, the patient may need to undergo certain tests, such as:

  • Routine blood test
  • Urine test to eliminate infection
  • Cystourethroscopy
  • Pelvic exam
  • Biopsy (in some cases)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Vesicovaginal Fistula Repair procedure?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is there an emergency?
  • How will this procedure help?
  • Will I need adjunct treatments after the surgery? 
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Is there any life style restrictions needed after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?

During the Vesicovaginal Fistula Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

A spinal anesthesia is given, using an injection to the spine, or a general anesthesia is given, by injection of anesthetics into the vein, as well as through inhalation using an air-tube (endotracheal tube) placed in the windpipe.

How much Blood will you lose, during the Procedure?

The amount of blood lost is generally minimal and there is no requirement of a blood transfusion, unless a complication arises.

What are the possible Risks and Complications during Vesicovaginal Fistula Repair surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Damage to the ureter, or urethral orifice
  • Infection
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after Vesicovaginal Fistula Repair surgical procedure?

  • The patient is kept under observation for a few days (like 4-6 days) after the surgery
  • The catheter that is placed in the bladder is generally removed, after 5-7 days
  • Apart from these, no other post-operative care is needed, unless any complications are seen to arise

After the Vesicovaginal Fistula Repair surgical procedure:

What are the possible Risks and Complications after Vesicovaginal Fistula Repair surgical procedure?

Post Vesicovaginal Fistula Repair procedure, the following complications may arise:

  • Excessive bleeding
  • Surgical wound infection
  • Urinary tract infection
  • Continued urine leakage through the fistula
  • Risks of abdominal and pelvic adhesions (if abdominal approach is used)
  • Risks of dyspareunia and tenderness (if vaginal approach is used)
  • Reduced vaginal length and caliber (if vaginal approach is used)

What is the Prognosis after the Surgery?

  • A complete healing without any complication can be expected after a Vesicovaginal Fistula Repair, in most cases
  • The tissue around the fistula is sent for a biopsy. The prognosis is guarded, if biopsy results are positive for the presence of cancer cells
  • Frequent occurrences of fistulas do not have a very good prognosis

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Urinary infection
  • Urine leakage
  • Fever, dizziness, nausea
  • Redness, swelling and pain
  • Any new symptoms that arise

What Post-Operative Care is needed at Home after Vesicovaginal Fistula Repair surgical procedure?

At home, the following post-operative care is recommended, after a Vesicovaginal Fistula Repair procedure:

  • Avoid all activities that are physically strenuous after the surgery, for a period of time, as advised by your healthcare provider
  • Be regular in taking the antibiotics and pain killers, as prescribed by the physician
  • Take stool softeners to prevent constipation, under advice by the physician

How long does it normally take to fully recover, from the Procedure?

It takes about 6 weeks, to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

  • The scar tissue surrounding the fistula is usually taken for biopsy, to check for the presence of cancer cells.
  • A qualified pathologist sends the tissue, taken out during the procedure, to a medical laboratory for further analysis
  • The tissue that is taken for further examination, is later disposed, as per the standard medical procedure

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Vesicovaginal Fistula Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The surgical facility of a hospital
  • The surgeon
  • An anesthesiologist (if anesthesia is administered)
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Umbilical Hernia Repair is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 23, 2014
Last updated: Sept. 4, 2018