Vaginal access
In the position for gynecological operations, the fistula opening is exposed, the scar tissue around it is excised, the bladder wall is separated from the vagina and sutured in two layers, then the vaginal wall; in case of thin tissues, a fat flap from the labia majora (Marcius) is moved between them. The bladder is drained with a catheter for 10–14 days; after cystography, the catheter is removed. Sexual life - after 2-3 months. The access is not suitable for high fistulas at the neck of the bladder, involvement of the ureters and a narrow vagina - then transvesical or transabdominal plastic surgery is performed.
Genitourinary fistulas
A fistula is a pathological connection between the urinary tract and the vagina, intestines or skin, in which urine constantly leaks. Causes: damage to the bladder during gynecological operations (cesarean section, hysterectomy), prolonged labor, radiation therapy, common tumors, trauma; renal-intestinal fistulas are a consequence of purulent processes and kidney tumors. The fistulas do not close on their own (except for very small ones when the bladder is drained); treatment is surgical plastic surgery with separate suturing of the organs and laying tissue between them.
Select access
Transvaginal fistulorrhaphy - for low vesicovaginal fistulas, low-traumatic; transvesical (through an open bladder) and transabdominal - for high, complex, multiple fistulas, involvement of the ureters and after radiation therapy. The first operation gives 90-95% success, so it is important to perform it in a specialized center and at the right time (2-3 months after injury, with radiation - 6-12 months).
