Problem with gynecological fistula
Gynecological fistula
Urinary fistulas (urogynecological fistula) are abnormal openings formed between either the bladder, the urethra, or the ureters, and the vagina. The result of this problem is the constant and uncontrolled leakage of urine from the vagina.
What is the cause
The most frequent cause in our population is a fistula formed after a previous operation. It can be caused by injury to the organs during surgical loosening. In such cases the problem is usually already diagnosed during the course of the operation, or shortly afterwards. In less clear cases it can be the result of thermal tissue damage, stitching through a ureter, the bladder, or urethra, or a so-called tissue ischemia caused by trauma to the blood vessels supplying these organs. In such cases the fistula can be discovered at a later date after the operation.
Other causes are:
Radiation of the pelvis as part of oncological treatment
This can cause trauma to the finer vessels and ultimately lead to the ischemia.
Inflammatory disease
Pelvic gynecological inflammation, diverticulitis or some other inflammatory disease of the intestines (Crohn‘s disease, proctocolitis, …) cause bleeding and fragility of the pelvic organs. This situation leads to worse tissue healing.
Birthing trauma
This type of fistula is rare in our society. It can be caused by trauma to the pelvic organs during a complicated surgical birth (vaginal or cesarean section). Another possible cause is ischemia of the soft tissue pinched between the baby’s head and the pelvic bone.
How the problem is diagnosed
The most common symptom is permanent leakage of urine
The main and most frequent symptom is the persistent painless leakage of urine through the vagina. The leakage might be intermittent, or diagnosed in certain positions (such as bending forwards, squatting) which changes the relative pressures in the pelvis.
The diagnosis is carried out in a urogynecological or urological clinic during a vaginal examination. There is either a visible direct outflow of urine or, it can be identified with the use of a coloured material which is applied to the bladder using a catheter.
In the case of hair fistulas, a diagnosis can be difficult because the leakage of urine can only occur in certain situations. In this instance, a colour test is used and a tampon applied to the vagina which is then checked after a certain length of time.
In some cases a cystoscope is used (to check the mouth of the ureters or to diagnose foreign materials). Imaging techniques may also be employed (magnetic resonance or CT scan)
How the problem is treated
It is best to treat a fistula as soon as possible after the diagnosis. The solution will depend on the location of the fistula. If a ureter is damaged, then only a long-term stent can help. This involves the positioning of a tube directly into the ureter which directs urine away and allows the wall of the ureter to heal spontaneously. If this is not successful, then a surgical intervention may be called for, which will be performed by an experienced urologist.
In cases of the most common openings between the bladder and vagina (known as vesicovaginal fistulas), a laparoscopic or vaginal approach are employed, or a combination of both. To lower the 20% risk of repeatedly occuring fistulas, a separate tissue is applied where possible, between the vagina and bladder, most frequently omentum (a large flat fatty tissue layer, located in the abdominal cavity in front of the intestinal tract). This omentum is also fixed in position with the use of absorbable stitches.
The risks of surgery
Complications related to thistype of surgery are, thanks to medical progress, very rare. There are certain complications that are associated with all types of surgery, such as thrombosis (the formation of blood clots in the veins, eg. in the lower regions of the legs) embolism (secondary blockage of the vessels with a blood clot, most often in the lungs) bleeding during surgery, infection in the field of operation, or a urinary tract infection. Even with the most carefully performed surgical techniques, there may be accidental, unintentional damage to the surrounding organs, such as a ureter, the large or small intestine to name but two. Such damage can lead to the extending of the planned surgical intervention, or even to a further operation.
After the operation, there may be some leakage of urine which must be resolved separately at a later date.
There may be some temporary problem with emptying the bladder which will resolve itself after a few days or, at most weeks.
The long-term success rate of this operation is over 80%. In the event of repeated fistulas, another operation should be performed in three months at the earliest.
Post-operative care
The most important of all is the care of the urinary catheter and, subsequently, regular urination and appropriate hygiene.
Official sick leave from work
It's been exactly one year since you performed a surgery on me and I remember asking you bluntly if you knew how to do it. And you do.
I do my number one like a big girl and sleep like a baby all night long, without a diaper.
- D.S.
The length of any sick leave depends on the difficulty of the surgery. This usually lasts until the removal of the urinary catheter. At home it is necessary to maintain a quiet regime which is important for thorough healing to take place, and for reconvalescence after the operation. In the event of problems (abdominal pain, bleeding, fever) after being discharged from hospital, we recommend an immediate check up. In any event, you will be invited for a planned check up in approximately three months after the operation.