For women who suffer from urethrovaginal fistulas, the situation is even more complicated because, in addition to fixing the fistula, it is usually necessary to do an anti-incontinence operation at the same time.
However, not all urethrovaginal fistulas create a problem and not all have to be surgically mended. If a urethrovaginal fistula is discovered during an examination by your urologist, but you have no symptoms or incontinence, there is no need to fix it. However, if incontinence is present, it usually means that the fistula affects not only the urethra, but the sphincter and bladder neck as well.
Surgeries to repair these types of injuries are much more complicated than the repair of a vesicovaginal fistula and require a very experienced surgeon. First, the surgeon has to fix the urethra, and then he has to repair the incontinence.
Because he or she is performing so much surgery in such a small space, it is typically wise to bring in a new blood supply to insure the best chance for healing. This can be done with a Martius labial fat pad graft. Despite the complexity of this surgery, in experienced hands, the overall success rate is over 90% with respect to continence and a successful fistula repair.
How Do You Repair Urethrovaginal Fistulas?
Typically, there are three different approaches to repairing these injuries:
- Anterior bladder flaps (Tanagho procedure)
- Posterior bladder flaps (Young-Dees-Leadbetter procedure)
- Vaginal wall flaps.
Although these techniques seem similar with respect to repairing the fistula, incontinence persists in about half of the women unless it is repaired at the same time. Dr. Jerry Blaivas, world renowned surgeon at Urocenter of New York advises that there is almost never a need to do anything but a vaginal repair combined with pubovaginal sling and Martius flap. Urologists Dr. Blaivas believes that vaginal reconstruction is considerably easier and faster, is much more amenable to concomitant anti-incontinence surgery and has a much easier recovery with much fewer complications and less blood loss.
Vesico-vaginal and urethro-vaginal fistulas (holes in the vagina connected to the bladder and urethra) are rare in industrialized countries, but are common in the third world because of inadequate obstetric care. The only treatment is surgical and in the hands of experienced surgeons the success rate is very high.
Even if the surgery should fail, a second operation or even a third will almost always be successful in expert hands. Whenever a fistula is diagnosed, a careful search for associated injuries to the ureter should be undertaken and, if found, these injuries should be repaired at the same time.
Call today to schedule a consultation:
Urocenter of New York