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Will The Bladder Opening Remain Post Fistula Surgery?

Posted on Fri, 20 Apr 2018

Question: My mother-in-law had a major open surgery on Nov last year. She had one of her kidneys removed and also had vesicovaginal fistula repaired. She is mostly healthy the entire year but her urinary incontinence remained as it was. 15 days ago we again had a check up with the same doctor. He said the hole is still there even though it is small and suggested robotic surgery. Is it common that the bladder hole may remain/reappear after fistula surgery? pls advise.

Answered by Dr. Dr. P. T. Patil (7 hours later)

Brief Answer:
Recurrence of Vesico Vaginal fistula is known .

Detailed Answer:
Hello
Thanks for query .
Based on the facts that you have posted your mother in law has some major kidney pathology and Vesico Vaginal fistula and has undergone surgery of Nephrectomy and repair of fistula one year back .However the fistulous communication is still there causing continuous leakage of urine from vagina.

I shall be happy if you can post me more details to help me in making precise comments
1) Since how long she has I shall be happy if you can post me more details to help me in making precise comments VesicoVaginal fistula?
2)What caused her to develop this fistula? Was it after any surgery in pelvic region ?

Vagina and Urinary bladder are separated by a thin layer of tissue however a abnormal communication (Fistula) develops between Vagina and Bladder in majority of cases by injury during surgery on uterus or during prolonged obstructed labor.

During surgery of repair of fistula this tract(Fistula) is excised and suturing of Bladder and Vagina is done in two layers with interposing a live vital tissue like Omentum so as to prevent recurrence of fistula .However it is known fact that in some cases the fistula repair fails due to avascular necrosis of the repaired site .

In such situation redo surgical repair with meticulous separation of bladder and Vagina and interposing a adequate amount of live Omentum is a prime requisite whether you do it by Robotic Surgery or by Open surgery .

I would suggest you to get it done by a XXXXXXX experienced Urologist .

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (2 hours later)

Thank you for detailed explanation. She had hysterectomy long back, which I think, was the reason for this fistula. She had this for 2 years before the vvf surgery last year. The delay was due to wrong diagnosis and treatment. She was being wrongly treated for bladder cancer for that period and was in catheter for the entire period(more than 2 year). The cancer was completely ruled out last year when we took her to a more advanced hospital. Along with VVF and kidney removal, they removed the ovary as well last year. I didn't get your question no 1 and the last but second paragraph because of typo( "Adequate amount of" ?)

Answered by Dr. Dr. P. T. Patil (46 minutes later)

Brief Answer:
She definitely have develope fistula due to injury during Hysterectomy .

Detailed Answer:
Hello
Thanks for follow up.

I got all the points she has developed Fistula due to injury during first surgery of Hysterectomy which was misdiagnosed and ill-treated .

Bladder and vagina which are deprived of blood due to avascular necrosis of the vagina resulting from injury during hysterectomy . Omentum is fatty tissue in abdominal cavity and is very vascular in nature and provides blood supply when interposed between Vagina and bladder and thus prevent recurrence of fistula .

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (20 minutes later)

Thank you Dr. So what do you think about this robotic surgery for repairing this hole for 2nd time. Is this risky? What could be the side effects? (Pro/cons)? Are there any other alternative we should look at. Can she be 100% cured?

Answered by Dr. Dr. P. T. Patil (30 minutes later)

Brief Answer:
Why you are insisting for Robotic surgery .

Detailed Answer:
Hello
Thanks for follow up .

Open surgery done by an expert and experienced Surgeon is the best way rather than going for robotic surgery that is still in a primitive stage in our country .

There is no risk involved in surgery except there are chances of failed surgery .That is why I am emphasizing to get it done by an experienced Urologist

There is no other option of treatment than a well planned and doing meticulous job.

If done meticulously the ressult of this surgery are rewarding and 100% successful.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Thank you for providing answers to all my questions. Just one more question though. What would be the recovery time as per you if everything goes well. The surgeon is a pretty experienced robotic surgeon.

Answered by Dr. Dr. P. T. Patil (2 hours later)

Brief Answer:
It would take 2-3 weeks for full recovery .

Detailed Answer:
Hello
Thanks for follow up .

It requires 2-3 weeks time for full recovery .

Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar