Urethro-vaginal Fistula. Treatment in Germany
Best hospitals and doctors for urethro-vaginal fistula treatment in Germany
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A urethro-vaginal fistula is an abnormal communication between the urethra and the vagina. In most cases, this is the result of an unsuccessful operation, and less commonly, this condition develops as a complication after childbirth or as a consequence of radiation therapy. There are also congenital fistulas that occur due to impaired intrauterine development. Any form of the disease can be cured. Doctors in Germany successfully cope with the treatment of even complex fistulas: post-radiation, with extensive urethral lesions, after the placement of a synthetic loop, etc. Doctors at German hospitals use the very latest surgical techniques, which are reliable, minimally traumatic, and safe.
Content
Doctors suture communications between the urethra and vagina or close the defect with a flap. After this surgery, some women will need additional procedures to correct stress urinary incontinence.
You can undergo your treatment at one of the following hospitals: University Hospital Rechts der Isar Munich, University Hospital Tuebingen, or University Hospital Ulm.
You are welcome to make your treatment appointment through our service, and we will fully arrange your trip. Medical advisors from the Booking Health company will select a clinic and a treatment method for you. The Booking Health managers will make an appointment at the clinic on the preferred date, help you to apply for a visa, take care of airline tickets and book apartments, if necessary. A medical interpreter will also accompany you at the clinic.
Features of treatment
The treatment of a urethro-vaginal fistula is more complex than that of a vesico-vaginal fistula. On the one hand, there is a significant tissue deficit, so most women need plastic surgery. On the other hand, the minimal space often does not allow any additional tissue to be placed between the walls of the urethra and vagina. However, German surgeons successfully cope with the task of treating urethro-vaginal fistulas.
The principles of treatment of the disease include the following:
- the tissue between the urethra and the vagina is sutured or flaps are used to restore it;
- various approaches can be used for operations: transurethral (from inside the urethra), transabdominal (through an abdominal incision), or transvaginal (through the vagina);
- interventions are performed with or without tissue interposition (enclosing or overlapping).
How is surgery performed?
In most cases, the operation is performed via a vaginal approach. This is a safe and sparing technique to perform the surgical intervention.
In the case of small fistulas and a preserved urethral wall, fistula closure can be performed without tissue interposition. The urethral wall is extensively mobilized and the tissues are sutured without tension in two layers using absorbable suture material. Additional flaps from the proximal (closest to the bladder) urethra may be used to reduce scarring and facilitate future loop placement if correction of stress urinary incontinence is required. The risk of this complication reaches 50%.
Doctors usually apply two rows of sutures to achieve tightness. After the first suturing, they check the leaks with a probe and then eliminate them.
The Martius modified labial fat pad flap (MMLFPF), or simply the Martius flap, is often used to separate the urethra and vagina. For the first time, Martius described urethro-vaginal fistula plastic surgery in 1928. This treatment method will soon celebrate its centennial, but it still remains relevant, although the technique has been repeatedly modified. As of today, the term "Martius flap" refers to an adipose tissue flap of the large lip without muscles. The flap is placed between the periurethral fascia and the anterior vaginal wall.
Management of urinary incontinence
Urinary incontinence is a common complication of operations for urethro-vaginal stenosis. Its likelihood exceeds 50%. The risk is even higher if a previously placed synthetic loop that was used to treat urinary incontinence is removed. A urethro-vaginal fistula may develop as a complication of this operation.
Due to the high risk of incontinence, there are proponents among doctors of a single-stage surgical resection of the fistula and placement of a synthetic loop. So far, this treatment method has not become the main one. Although the percentage of complications is high, not all women develop incontinence, so its treatment is carried out at the second stage. Half of the patients will not need it at all.
However, if stress incontinence has developed, it can be easily eliminated. For this purpose, doctors use sling techniques, that is, minimally invasive procedures with a short rehabilitation period. With a curved trocar needle, doctors insert a loop through a small vaginal incision, which fixes the urethra at an angle. The effectiveness of new modifications of sling operations reaches 95%.
You can undergo your diagnostics and treatment of urethro-vaginal fistula in Germany in one of the specialized Urogynecology Centers to obtain reliable results and minimize such complications as urinary incontinence or urethral stenosis. You are welcome to use the Booking Health service to find the cost of treatment and make an appointment at a hospital at an affordable price. Our specialists will help you to select clinics in Germany and arrange your trip.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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