Vesicovaginal Fistula Repair

WHAT YOU SHOULD KNOW:

Vesicovaginal Fistula Repair (Inpatient Care) Care Guide

  • Vesicovaginal fistula repair is surgery to close or remove a fistula between your bladder and vagina. A fistula is an abnormal tissue connection or hole. Your bladder is an organ at the bottom of your abdomen (stomach) where urine is stored. Your vagina is the opening through which you have your monthly period and give birth. Urine normally flows from your kidneys into your bladder through your ureters. From your bladder, urine flows out of your body through your urethra. When you have a vesicovaginal fistula, urine will exit your body through your vagina. When this occurs, you will not be able to control the flow of your urine.

  • Vesicovaginal fistulas may happen after having surgery to remove your uterus (womb). Fistulas also may occur after having surgery on your urethra. Radiation to treat cancer of the cervix (the opening of the uterus) also may cause a fistula. During surgery, your caregiver closes or removes the fistula to prevent urine from leaking. Surgery may be done through your vagina, or through incisions (cuts) in your abdomen. Having your vesicovaginal fistula repaired may decrease your risk for skin infections and irritation from leaking urine. Surgery may decrease, or completely stop the leakage of urine through your vagina.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • During surgery your ureters may be damaged, or you may bleed more then expected. After surgery, you may have bleeding, pain, bladder spasms, and you may get a wound infection. You may get a urinary tract infection (UTI), bladder stones, or not be able to empty your bladder completely. You may still leak urine or have urges to urinate often. Surgery also may make your bladder smaller, and shorten your vaginal canal. Even after having surgery to remove your fistula, a new fistula may form.

  • If you do not have vesicovaginal fistula repair, you will continue to leak urine through your vagina. You will be unable to control the leakage of your urine. This may lead to infections in your vagina, bladder, and in the skin around your vagina. You may have pelvic pain and worsening bladder pain and spasms. Talk to your caregiver if you have questions or concerns about your condition or care.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Medicines:

    • Antibiotics: You may be given antibiotics to help prevent an infection caused by germs called bacteria. Antibiotics may be given before, during, and after your surgery.


  • Pre-op care: You will be taken to the room where your surgery will be done. You will lie on your back and your legs will be held up with supports.

  • Anesthesia medicine: Anesthesia is medicine to make you comfortable during your surgery.

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.


  • Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The catheter is normally inserted after you have had anesthesia. The catheter may be left in for 1 to 3 weeks after your surgery to constantly drain your urine. Leaving a catheter in place also will allow the surgery area to heal.

  • Nasogastric tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty during surgery.

During your surgery:

  • A cystoscope will be inserted through your urethra to check the location of your fistula. A cystoscope is a long metal tube with a lens and light on its end. The scope also will be used to check your ureters, and place a stent in each ureter. The stents are used to protect your ureters during your surgery. A tube is also put into your fistula through your vagina to mark the area for surgery. If your surgery will be done through your vagina, an incision (cut) will be made around the fistula. The fistula will be cut out and removed, or sewn closed. The outside walls of your vagina and bladder will then be separated. The cuts made in your vagina and bladder will be closed with stitches.

  • If your surgery will be done through your abdomen, a cut may be made under your umbilicus (belly button). Your bladder may be filled with a salt solution through your Foley catheter. Your caregiver will then cut down through your bladder until he reaches your fistula. The wall of your bladder may be cut away from your vagina. The fistula is then cut away from your bladder and vagina. The cuts in your bladder and vagina are closed with stitches. A suprapubic catheter may be put through your abdomen and into your bladder before it is closed. The catheter is used to drain your urine and normally stays in place for 1 to 3 weeks. A layer of body tissue or fat also may be sewn over the stitches to protect the areas.

  • Before closing your abdomen with stitches, a drain may be placed inside your cut. The drain will help remove any extra fluid from your wound (surgery site). Bandages may be placed over your abdominal wound to keep the area clean and dry. Your caregiver also may put bandages soaked with germ-killing medicine inside your vagina. The medicine-soaked bandages may be used for both the abdominal and vaginal type of this surgery.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. Caregivers will watch you closely for any problems. When caregivers see that you are not having any problems, you may be taken back to your room. The bandages in your vagina may be removed 1 to 2 days after your surgery. If you have a drain in your wound, it will be removed when little or no fluid is draining out.

  • Medicines:

    • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

      • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

      • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

    • Anticholinergic medicine: This medicine is given to help relax your bladder and prevent bladder spasms.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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