Vesico-Vaginal Fistula - Malpractice Lawyers Compensation Claim

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Vesico-Vaginal Fistula - Medical Malpractice

A vesico-vaginal fistula or a uretero-vaginal fistula are complications of just about any female surgery. About half of all fistulae occur at the time of a hysterectomy. A hysterectomy is done for uterine fibroids, uterine cancer, menstrual dysfunction, and uterine prolapse. It is successful without damage to the urinary tract in about 96 percent of cases. In four percent, there is damage to the ureters or bladder. Bladder punctures occur about 2 percent of the time but doesn't always form a vesico-vaginal fistula. A fistula forms as a result of an untreated puncture of the bladder wall that becomes infected, inflamed and enlarged to result in dribbling of urine through the vagina. It can occur from surgery to the hysterectomy or from surgery to the bladder or to radiation to the pelvic area. A fistula can form many years or months after the radiation.

Vesicovaginal fistulae are not new conditions. It was described since the time of Hippocrates and was associated with difficult vaginal births. At this time, it still occurs in women who have difficult births in undeveloped or developing countries. The women are ostracised from the village due to their constant urinary tract difficulties. In developed countries, only a bad vaginal or uterine surgery is a cause of vesicovaginal fistula in the vast majority of cases.

Doctors can repair the fistulae using an abdominal or transvaginal approach. The abdominal approach is the simplest and the fistula can be repaired with good visualisation of the bladder and the fistula. The abdominal approach is more dangerous, however, and results in a scar. The doctor can otherwise do a transvaginal approach, in which a speculum is inserted into the vagina and the fistula is removed with the bladder repaired easily. A ureterovaginal fistula is difficult to do during a vaginal procedure because it is hard to get access to the ureters in a vaginal approach. If at all possible, however, a vaginal approach is preferred because women find it more comfortable and easier to heal from.

Urine can freely flow from the urinary tract into the vagina so that there is the appearance of urinary incontinence. It can dribble all the time or can dribble out of the vagina only during urination, such as when the bladder is under the greatest pressure. If the defect is between the ureter and the vagina, the bladder is bypassed and the urine drains from the ureter directly into the vagina and this tends to be constant dribbling. Some fistulae are very complicated. They can go through many organs and tissues before coming out into the bladder and vagina. The bowel can become part of the fistula, leading to chronic bladder infections and stool coming out of the vagina along with the urine.

The most common cause of a vesicovaginal fistula is the injury to the bladder during a hysterectomy or other pelvic surgery. Even a caesarean section can result in a bladder fistula. The bladder wall is very thin and, if the bladder isn't fully emptied via a catheter during the surgery, there can be an inadvertent nick of the bladder. This is why the doctor creates a bladder flap that protects the bladder during a caesarean section. Even so, dissecting the bladder from the uterine wall is tricky and can result in puncture or tears of the bladder wall.

Doctors can do a vaginal cuff suture during a vaginal hysterectomy that can accidentally include part of the wall making a natural connection between the vagina and the bladder. If the circulation is cut off at the time of the surgery, a fistula can form between the bladder and the vagina that is difficult to treat. It is the necrosis in the bladder that results in a hole formation and a fistula with the vagina. Surgeries with a lot of bleeding and that are complex in nature have a greater risk of having a vesicovaginal fistula.

Cystogram of vesicovaginal fistula. Note the contrast extravasating from the bladder into the vaginal canal.

LEGAL HELPLINE: ☎ 855 804 7125

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