Vesicovaginal fistulas are a rare complication of hysterectomy with an incidence of 0.1% to 0.2%; . Although many of the factors listed above increase the risk of fistula development, most posthysterectomy vesicovaginal fistulas occur after an apparently uncomplicated total abdominal hysterectomy for benign disease. Steps to avoid fistula formation include identification of the proper plane between the bladder and cervix; use of sharp dissection to develop the bladder flap rather than blunt dissection or use of electrocautery, ensuring that the bladder is dissected below the level that the cervix will be transected from the vagina; and intraoperative identification of any lower urinary tract injury using the techniques previously outlined. Animal studies suggest that vesicovaginal fistulas result from unrecognized bladder injuries. Unrecognized suture placement into the bladder at the time of cuff closure is unlikely to result in fistula formation in the absence of a concurrent bladder laceration. Patients who develop a vesicovaginal fistula typically have a difficult early postoperative course followed by development of watery drainage from the vagina 10 to 14 days after surgery. If not readily apparent on vaginal examination, the diagnosis can be made by instilling the bladder with dilute methylene blue or indigo carmine dye and placing a tampon into the vagina. If the dye is noted on the tampon, then a fistula is confirmed. If there is no dye apparent, ureterovaginal fistula must be ruled out by intravenous administration of indigo carmine dye or radiologic evaluation of the ureter with an intravenous pyelogram or computed tomography scan. Small fistulas may heal spontaneously after 6 to 12 weeks of continuous bladder drainage. For those that do not heal spontaneously, surgical repair is required
Dr Mangirish Kenkre (MS) , is an advanced Gynecologic Laparoscopy Surgeon who has performed over 5000 successful Laparoscopic procedures and specializes in treating various gynecologic diseases such as Fibroids, Adenomyosis, Endometriosis, Ovarian tumours , Congenital Anomalies (MRKH- Vaginoplasty), Fistulas and malignancies (cancer) of the uterus , ovaries and cervix. Dr Kenkre has to his name multiple research papers published in various national and international journals of repute. He has also delivered many presentations on Advanced Laparoscopy at numerous conferences.
Contact : +917666447922
Email : drkenkrelaparoscopy@gmail.com
Hospital Affiliations -
RG Stone Urology and Laparoscopy Hospital, Porvorim , Goa.
Surgery for Fibroid Removal- Laparoscopic myomectomy
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Surgery for Uterus Removal - Laparoscopic hysterectomy
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