URETHRO VAGINAL FISTULA REPAIR

Initially the patient was taken to the operating room and general anesthesia was performed. To cannulate the fistula tract, 4-French Fogarty endarterectomy catheter was used and this was done with cystoscopic visualization.

Hydrodissection of the vaginal epithelium was done with dilute vasopressin. Surrounding to the opening of the fistula a circumferential incision or cut was made. The epithelium was cautiously dissected off of the underlying fibromuscular layer to organize 2.5 cm of tissue circumferentially.

The classic procedure of genitourinary fistula repair calls for the whole excision of the fistula tract cutting the edges till the fresh vascular tissue is recognized. Though a Latzko procedure stipulates that the fistula tract is been left in place with no attempts to excise it or the tissues which are surrounding.

Latzko repair is done to the patient. Closure over the fistula opening was done in a series of layers by using delayed absorbable suture. A labial fat pad was formed by making a cut or incision on the surgical aspect of the labia majora and dissects down to a level of the bulbocavernosus muscle to assemble the underlying fat pad.

Care to be taken to avoid compromise of rich supply of blood at the inferior part of the pedicled graft. The graft was then tunnelled underneath the vaginal mucosa to cover the area of fistula repair.

The fat pad was protected and then the overlying epithelium was reapproximated. At the completion of the surgical treatment the patient had a transurethral and suprapubic catheter is left in the place for temporary drainage of the bladder.