Dr Vijayant Govinda Gupta is a Urogynecologist in New Delhi India who specialises in the management of Urinary Fistula repair in women. Today I discuss a case of a 35 year old women who presented with a Ureterovaginal fistula after a Laparoscopic hysterectomy.
Ureterovaginal fistula (UVF) repair with Baori Flap in New Delhi India
History of Patient
35 year old Indian mother with previous 3 live births underwent laparoscopic hysterectomy at a peripheral hospital in November 2019. Post surgery patient had uneventful recovery. Then after 2 weeks she presented again with continuous urinary leakage to her gynecologist.
On examination she had a fistula present in the vaginal cuff. She was catheterized and referred to me.
On cystoscopy, there was no fistula in the bladder. Left ureteroscopy revealed cut off 2 cm from UV junction. Over guidewire, ureter was cannulated and DJ stent placed to drain left kidney.
CT scan revealed dye leak from left kidney into vagina. Decision was made to explore patient and do a formal repair of the UVF.
Intraoperative Steps of Ureterovaginal Fistula repair
Decision was made to do a open repair. As patient could not afford laparoscopic or robotic surgery.
On exploring patient, DJ stent was found lying at the vaginal cuff.
The ureter was dissected off the ilacs. There was severe adhesions. Approximately 3 cm of ureter was unusable. Ureter was disconnected proximal to the superior vesical crossing.
Cause of the fistula must have been energy source leakage. The ureter was definitle due to use of cautery current.
The healthy ureter could not come to the bladder without tension. so decision was made to do a Baori Flap reconstruction.
Baori flap reconstruction for fistula
A 5 cm into 2 cm baori flap was marked and brought to the ureteric stump. The flap was reconstructed and ureter reconstructed.
The abdomen was closed over a drain and patient was discharged dry and healed after 10 days.
Best care for Ureterovaginal fistulas in the world
Dr Vijayant G Gupta provides the most advanced reconstructive urology care in the world at the most reasonable pricing anywhere. Write to admin@drvijayantgovinda.com for discussion and consult.
