Urethral-vaginal fistula surgery: What you need to know

The article was consulted professionally by Doctor Department of General Surgery and Anesthesia, Vinmec Hai Phong International General Hospital.

Vaginal fistula is the presence of an abnormal opening that connects the vagina to the bladder. This is a disease that affects a lot of patients' quality of life, so it needs to be treated early. Vaginal fistula surgery is the ideal treatment for the patient.

Vaginal fistula is an abnormal opening that connects the vagina to another organ such as the bladder, rectum or colon. Vaginal fistulas can be congenital or occur after an injury, surgery, infection, or radiation therapy. Symptoms of the disease are weak urine stream, partial leakage of urine into the vagina. And whatever the cause, the general principle of treatment is to close the fistula, avoid infection upstream of the urinary system, and restore quality of life.
In the case of a small urethral-vaginal fistula, the doctor will apply the methods of electrocautery, injection, bio-glue, combined with bladder drainage to help the fistula become scarred. In other cases, surgery will be required.
Before performing surgery, the doctor will check that the surrounding tissue is healthy, if no need to heal first. For patients with inflammatory bowel disease, doctors will not perform urethro-vaginal fistula surgery when symptoms flare up.
Advice for patients is to perform surgery soon when the tissues around the leak site are still soft and have not been hardened due to prolonged inflammation. From the fistula, the doctor will dissect the tissue with an area large enough to close the fistula.

2.1 Indications and contraindications Indications
Congenital vaginal fistula; Vaginal urethral fistula due to acquired causes. Contraindications
When you have a urinary tract infection. 2.2 Preparation for surgery The patient and family need to be explained before surgery about the medical condition, general condition, possible complications due to surgery, anesthesia, geographical location,...; Improve physical condition, balance body disorders caused by chronic or physical diseases; Stable treatment of medical diseases such as hypertension, diabetes,... before surgical intervention (except for emergency surgery); Blood transfusion if the patient has a lot of anemia; Fasting, enema, full body hygiene, especially the surgical area; Use prophylactic antibiotics before surgery; Equipment: Major surgery set. 2.3 Performing surgery Place the patient in the obstetric position; Disinfect the abdomen below the navel, vagina and perineum; Vaginal exposure and urethral-vaginal fistula; Stitch the baby's lips to the skin, put a urethral catheter, place the valve on the back of the vagina; Fistula surgery; Inject lidocaine solution + 0.9% saline serum + adrenaline 1:200,000 into the submucosa of the vaginal wall; Incision around the circumference of the fistula in the vaginal wall, separating the vaginal wall from the fistula and the urethral wall; Fistula resection closes the fistula in the urethral wall by slow criteria; Close the vaginal wall; Place the betadine-impregnated sesame paste vaginally.

2.4 Monitoring and managing complications Monitoring
Infection of the incision: The incision is red, festering, perineal hematoma; Difficulty urinating: After the catheter is removed, the patient has difficulty urinating or cannot urinate at all. Treatment of complications
Infection: Need to change the bandage, put vaginal betadine-impregnated gauze; Difficulty urinating, urinary retention: Reinsert urethral catheter, save catheter for 3 days. After surgery for urethral-vaginal fistula, patients need to follow the doctor's instructions in care, hygiene and nutrition. If there are unusual signs such as fever, pain, swelling or redness at the surgical site, the patient should seek medical attention immediately.