Hi.. I had a hysterectomy (laparascopically assisted) on 8/5/99 and the gynecologist accidentally severed my left ureter. 9 days later I had leaky discharge from the vagina. My gynecologist thought it was plasma and didnt pay much attention to it and said it would heal naturally. 2 weeks later, he finally took a sample of the discharge from vagina to a lab and discovered it was urine! He then referred me to a urologist who did several tests including IVP and Cystogram. They say I have a fistula from the ureter to the vagina and they took me to the operating room again and tried to insert a JJ double stent from below - however they were unsuccessful. The next day a interventional radiologist tried to use a guide wire through the kidney to insert the stent - however this was not successul either and now I have a nephrostomy bag. Here are my questions:
(a) does this nephrostomy bag supposed to hurt - I have to take percocet 3x/day (it has been 5 days since I have had this bag) and I can't sit back (hurts on left side) and can't stand for too long?
(b) the next step is open surgery according to the urologist -- left ureteral replantation with a (psoas?) bladder lift? -- can u tell me the prognosis of this procedure? will I expect a lot of pain?
(c) i will be having this surgery in 3 weeks because the doctor is going on vacation.. is it okay to have this nephrostomy tube in 3 weeks and will postponing the surgery for 3 weeks have any ill effect on my ureter?
(c) if this procedure doesn't work? what next?
Thank you for your advice.
What you have is referred to as a ureterovaginal fistula , which is the most common urologic complication following hysterectomy. What has been done for you is essentially standard. I will try to answer your questions one by one.
a)- A nephrostomy site tends to be painful in the first few days following its placement. This gradually changes to mild to moderate discomfort in most patients and does not cause too much pain. It tends to be more uncomfortable in cases where the initial placement was difficult. If your pain persists your doctor should evaluate the insertion site. Meanwhile you should make sure that your nephrostomy tube is not plugged up and is draining well.
b)-The outcome results of a ureteral reimplantation with a psoas hitch, which is proposed to you, is very good. In some series a 100% successful outcome has been reported. The post operative pain usually gets better within a few days, and most people tolerate it well with some oral pain medication.
c)-Having the nephrostomy tube in for several weeks prior to surgery is not a problem, and should not complicate the outcome of your surgery for ureterovaginal fistula.If this diagnosis is missed at the first 24 to 48 hrs. after the initial surgery, the repair should be delayed for about six weeks , so that the post operative inflammation and changes would recede, allowing for a better and more successful repair. So your waiting is not a problem.
d)-The use another variant of
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