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Vesicovaginal fistula HELP!!!!!

I year ago I was diagnosed with a vesicovaginal fistula.  We tried a foley catheter for many weeks to see if it would heal.  No such luck. We then tried to repair it surgically through the vagina.  Again, no such luck.  One month ago, they inserted a second catheter into the fistula.  

There is a big improvement of the leakage at night when I am in bed and horizontal.  Sitting, is a whole other story.  Even though I am using adult disposable underwear with a secondary pad in them, I still leak through to my clothes and there is usually a puddle on the floor where it leaks down the 2 tubes.  I recently lost a job that I held with the same company for 25 years because of this problem. It is also dificult to interview, carrying 2 catheter drainage bags and being petrified that I will leak through my dress or worse yet leave a puddle when I stand up.

My urogynecologist and I keep going around in circles, he discusses the ethics of operating on me again with such a low probability of success and I argue the Quality of Life Issues.  We are at an impass.  

Any suggestions that you can suggest would be greatly appreciated.  Iam really at a loss as to what to do next. I find it very difficult to live this way.  I was the primary source of income in our family, and now I am unemployed. I am getting frantic about this "hole" mess.
2 Responses
242593 tn?1313867921
MEDICAL PROFESSIONAL
Is the fistula related to : childbirth? Hysterectomy or pelvic surgery? Was the pelvis ever radiated for cancer? e.g., cervical or endometrial cancer? These are important questions that can impace success. That said, there is an abdominal approach to the repair of the vesicovaginal fistula. It involves llifting the bladder off the vagina, and repairing the bladder in multiple layers, and then placing a piece of Omentum (vascular fatty tissue from around the intestine) under the repair, in order to keep it from recurring. There are many pelvic surgeons who are trained to do this, myself included. The success  (even after a repeat) depends on the size of the fistula, the location (near to or far from the ureters), the vascularity of the bladder tissue and the repair technique. You are right, subsequent repairs have a lower success rate than the initial repair, In addition,radiated tissue (e.g after cancer radiation)  probably has the lowest chances of long term success.
If you need further information, send an email ***@****.

Dr. Hoyte
242593 tn?1313867921
MEDICAL PROFESSIONAL
mail: lhoyte -at- health -dot- usf -dot- edu
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