Separation of the kidney and intestines
The diagnosis is confirmed by MSCT with contrast, fistulography, colonoscopy. Through laparotomy access, the surgeon identifies the affected area of the intestine and the kidney, crosses the fistulous tract, the intestinal defect is sutured in two layers or a resection of the segment with anastomosis is performed; The pelvic defect is sutured with a nephrostomy and a stent, and an omentum is placed between the organs. If the kidney is not functioning (which often happens with pyonephrosis), a nephrectomy is performed - this radically eliminates the fistula. The operation requires the participation of a urologist and abdominal surgeon, bowel preparation and antibiotic therapy.
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).
