2013 Annual Meeting-An Improved Urinary Drainage Device for Management of Vesicovaginal Fistula

Video Transcription

Development of a vesicovaginal fistula is one of the most distressing surgical complications that occur in women.  In developed countries, total abdominal hysterectomy is the major cause of vesicovaginal fistulas. Posthysterectomy fistulas are usually located at the level of the vaginal cuff.  In the bladder, this usually corresponds to the supratrigonal area between the ureters.  While awaiting repair of such a fistula, some temporary relief from urine leakage can be obtained with a device that was described by Nichols.  A standard Foley catheter is inserted through a small hole in a contraceptive diaphragm. The device is placed into the vagina and connected to a leg bag.  We have observed that one disadvantage of this method is that the drainage hole of the Foley catheter is relatively high  and the diaphragm must be nearly filled with urine before drainage can occur. A modification of this technique can be accomplished with simple tools, including a 5 mm punch biopsy,  a 22 French malicot drain, and a contraceptive diaphragm. A flexible contraceptive diaphragm is sized to fit the patient.  A 5 mm punch biopsy will be used to create a hole in the diaphragm. A 22 French malicot drain is substituted for the Foley catheter.  The tip is pliable but can be straightened and lengthened with a rigid catheter guide. The 5 mm punch biopsy is used to create a hole in the contraceptive diaphragm.  The rigid obturator is used to straighten the drain during insertion through the diaphragm. This is done to avoid tearing the diaphragm.  Once it is removed, the malicot drain returns to its normal shape.  Compared with the Foley catheter, the drainage hole of the malicot drain is low and nearly flush with the bottom of the diaphragm.  This means less urine accumulation in the diaphragm before drainage occurs and less leaking around the device. This device can accommodate significant urine production.  The device is again placed in the vagina and connected to a leg bag.  This urine collection device can be worn until granulation tissue and inflammation subsides, allowing optimal surgical repair.

Video Summary

This video discusses the development and complications of vesicovaginal fistulas in women, particularly after total abdominal hysterectomy. The usual location of posthysterectomy fistulas is the vaginal cuff, which corresponds to the supratrigonal area between the ureters in the bladder. To temporarily alleviate urine leakage before repair, a device described by Nichols is often used. However, it has the disadvantage of requiring the diaphragm to be almost full before urine can be drained. A modified technique involves using a 5 mm punch biopsy, a 22 French malicot drain, and a contraceptive diaphragm. This device has a lower drainage hole, reducing urine accumulation and leakage. It can be worn until the surgical repair is optimal. No credit is given in the transcript.

Meta Tag

Category surgical video

Category fistula-vesicovaginal

Category surgery

Category Novel Therapies - Techniques

Category fistula

Category PFD Week 2013

Session 182177

Keywords

vesicovaginal fistulas

women

total abdominal hysterectomy

urine leakage

surgical repair