Explain: Vesico-vaginal fistula

Content: Vesicovaginal fistula repair

Clinical Information:

The female patient had persistent urinary leakage after the previous pelvic surgery.

Urethography: Vesicovaginal fistula

Urogynecologic ultrasonography {{ +, -}}.

Cystoscopy: {{ +, -}}.

Urodynamic study {{ +, -}}.

Micro-tip urodynamic study: {{ +, -}}.

Pad test : gm.

Urogynecologic ultrasonography {{ +, -}}.

Previous pelvic surgical history: [[no, RAH, Radio therapy, Burch, Laparoscopic Burch, EBNS, Raz, Stamey, TVT, anterior colporraphy, posterior colporraphy, VTH, colposacropexy, S-S ligament suspension, others]]

Operative Procedures:

Type of operation: Vesicovaginal fistula repair + [[VTH, anterior colporraphy, posterior colporraphy, S-S ligament suspension]].

With adequate expose, the fistulous tract is excised with a scalpel incision around the circumference of the fistula. The margin of the fistula tract is then elevated with thumb forceps and exised with Metzenbaum scissors. The entire tract is dissected. The layers of the bladder wall and vagina is adequately delineated, and each of these layes is mobilized to allo the layers to be drawn together without tension. The bladder mucosa is identified and closed with interrupted suture. A second layer, the bladder muscle, is completely closed over the fistula area with 2-0 Dexon. The bulbocarvernosus muscle from beneathe the labia majora is tunneled for the external blood supply. {{Suprapubic cystostomy and Urethral Foley, A urethra Foley}} was placed for urinary drainage.

Operative Findings:

Vesicovaginal fistula tract: {{ trigone, bladder dome, bladder base}}

Suprapubic cystostomy: {{ yes, no}}

Urethral orifice: {{patent, obstuct}}

Urethral canal: {{intact, disrupted}}

Right ureter orifice: {{patent, not seen}}

Left ureter orifice: {{patent, not seen}}

Trigone: {{smooth, hemorrhage, congestive}}

Bladder mucosa: {{smooth, hemorrhage, congestive}}

Complication: [[massive bleeding, ureter injury, bladder injury, urethra injury, _______________]].

Dr:________________. Date: _______________.