Treatment of Vesico-vaginal Fistula in Germany

Diagnostics

Large fistulas can be detected during a gynecological examination. A fistula of the minimum size can be found with a dye, which is injected into the bladder and then detected in the vagina.

Doctors use urethrocystoscopy to determine the location and direction of the fistulous tract. This is an endoscopic examination involving the insertion of a tiny video camera into the urethra and bladder.

To exclude the pathology of the upper urinary tract, ultrasound scans, excretory urography, CT or MRI scans can be performed.

Treatment principles

More than a hundred operations are known to be used for vesico-vaginal fistulas. However, the basic treatment principles were formulated in the nineteenth century. In 1857, M. Collis proposed a splitting technique according to which the bladder and vaginal walls are separated to be sutured separately. Since then, the techniques of the surgical procedure have improved, but the key principles remain the same. The surgical treatment of the disease involves the following:

• scar removal; 
• separation of the vaginal septum from the bladder; 
• tissue mobilization; 
• alternate suturing on the bladder and vaginal walls (doctors try not to stretch the tissues);
• prolonged bladder drainage after surgery, which lasts from 10 to 30 days.

Doctors use the following three types of surgical approaches: transvesical (through the bladder), transabdominal (through an abdominal incision) and transvaginal (through the vagina).

In 30% of cases, the fistula can simply be closed with sutures. In 70% of cases, doctors have to perform plastic surgery with local tissues (plastic reconstruction) to create a partition between two communicating organs.

Features of the treatment of post-radiation fistulas

Standard techniques are usually ineffective for post-radiation fistulas, since, under the influence of radiation therapy, tissue tropism is disturbed and regeneration worsens. Therefore, plastic surgery with local tissues is not performed.

In such situations, doctors use pedicled flaps from the areas of the body that have not been exposed to radiation to form a partition between two organs. They often take muscle, adipose tissue, or fascia. The skin is also often included in the composition of the flap.

Minimally invasive surgery

When dealing with the treatment of vesico-vaginal fistula in Germany, doctors often use minimally invasive techniques, which make the surgical intervention less traumatic, speed up rehabilitation and reduce the risk of complications.

In 1994, the world's first laparoscopic treatment of a fistula was carried out, and in 2005, the first robot-assisted operation for this disease was performed. Today, this treatment option is used more and more often in specialized centers, as it is considered the safest.

You can travel to Germany to undergo advanced and safe treatment in a modern hospital. You are welcome to use the Booking Health service. On our website, you can find prices, compare the cost of medical services in different hospitals, and make your appointment on the preferred dates at the best price. Our specialists will help you to choose the most suitable clinics in Germany and organize your trip. The cost of services for you will be reduced due to the absence of additional fees for foreign patients.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova 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!

Sources:

Verywell Health

NHS

The Lancet