Management of post-operative urinary tract fistula - abstract

ABSTRACT

Urinary fistula is a tragedy. We present 8 patients, 33 to 49 yrs. of age, without malignancy, seen over a 16-month period, who had post-operative urinary tract fistulae. The antecedent surgery was gynaecological/obstetrical in each case. In 6 patients, the fistulae followed abdominal hysterectomy, and in 2, it followed caesarean section. The diagnosis was made by simple clinical inspection of the introitus to confirm urinary leakage; this occurred 2 to 8 days after surgery. Intravenous urograms were done to identify ureteric damage specifically, and provide information on the integrity of the upper tracts. Four women had vesico-vaginal fistulae, 3 had ureterico-vaginal fistulae and one had both bladder and ureteric damage. The urinary tract fistulae were repaired at three weeks rather than at 3 months, the conventional time for repair. We used a z-layer repair for the vesico-vaginal fistula (longitudinal vaginal and transverse vesical), using 20 or 30 chromic catgut. Ureteric damage was managed by a non-refluxing reimplantation procedure. The Foley balloon was not inflated, and the catheter was carefully observed to ensure free drainage. Five healed without complication; one ureterico-vaginal fistula developed abdominal leakage due to a blocked catheter, which healed after catheter change 1 vesico-vaginal repair leaked when the catheter was removed at 14 days post-operatively, recatherisation for three weeks was successful; and in one patient, the procedure failed. In this last patient, the fistula recurred after her first repair; she remained dry for 6 weeks after a further attempt but then the fistula recurred (AU)