Vesicovaginal fistula (VVF) is an abnormal channel in between vagina and bladder that may results in leakage of urine. It is generally related with gynecologic methods such as abdominal hysterectomy. Surgical treatment of the repair remains the main technique of treatment after a attempt of failed conservative measures. Currently, several surgical treatments are developing for VVF treatment based on the size of the fistula, severity, etiology, location and experience of the surgeon. The Vesicovaginal Fistula Repair method can be performed in 2 ways – primary way is by using an open approach and a laparoscopic approach.
OPEN VVF REPAIR:
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Initially anesthesia was performed, after that a speculum is used to hold to open the vagina. The scar tissue surrounding the fistula is cut free and removed. A healthy tissue is interposed in between the 2 layers of the fistula.
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Then with suture bladder and vaginal wall are closed, which will be absorbed by the body
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The bladder is then filled with sterile water and search if there are any leaks. If leaks are observed further repairs is made. If no leaks are observed, then a catheter is inserted into the bladder
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The urine that is there in the system is acidified to avoid the formation of any precipitations.
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Usually repair of VVF whole procedure takes around 2-6 hours to be completed.
LAPAROSCOPIC VVF REPAIR:
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A Foley catheter from the fistula is inserted vaginally by cystoscopy it was taken out into the bladder.
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A primary 10 mm port is placed at the umbilicus, and then established the pneumoperitoneum regularly. 2 other ports (5 and 10 mm) were inserted in the inferior abdominal wall.
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Then lateral peritoneum is opened with the help of endoscopic scissors and the vesico-vaginal space is accurately developed until the bladder is totally freed posteriorly from the vaginal wall and the catheter should not be seen.
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After catheter removal, the fistulous tract and injurious tissue margins may be dissected carefully. Later, the openings of the tract both on the vagina and bladder sides are sutured and closed by Vicryl.
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A suprapubic drain tube is left in place and bladder drainage is accomplished by a urinary in dwelling of a Foley catheter.
