Bladder access
Through an incision above the pubis, the bladder is opened, the fistula opening is visible from the inside; Stents are installed at the mouths of the ureters in their proximity for protection, the fistula is bordered and excised, the vaginal wall is sutured from the bladder side, then the bladder wall is sutured in two layers. Good visualization of the triangle makes this approach safe for fistulas near the ureters. The bladder is drained with a urethral catheter and suprapubic tube for 10–14 days. The operation is often combined with a transabdominal stage for complex fistulas.
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).
