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  Hysterectomy 8/11/98, kidney infection, kidney swelling, stones formed.  Totally incontinenent since 8/18/98, size 22 catheter marble size clots 10 min irrigation, hospitilizations. Extreme pain. (catheteter removed due to pain.)  Need surgury to remove bladder sutures & tears and fistula.  Can this be done laparoscopally, horizontially, or vaginally.  I don't want vertical incision.  Have Blue Cross/Blue Shield Coverage. Live in Hawaii, no Dr.'s here able to perfor.  Stanford? Mayo in Phx?  HELP...THANK YOU
Dear Angie,
The problem you describe is called a vesicovaginal fistula. This occurs in patients after difficult hysterectomies most commonly. These can be corrected surgically through the vagina, via the abdomen either through either a vertical incision or bikini incision. Due to the other problems you describe with regard to stones and bladder tears it may be feasible to perform this via a bikini incision ( called Pfannenstiel ).
Fistulas are repaired by closing them with sutures in several layers.. If they are quite extensive or there are other complicating factors such as  preoperative radiation , various flaps are  performed using muscle from the leg (gracilis ) or abdomen ( rectus ).
Extensive problem such as yours should be managed at a major institution. Any of the major California institutions ( UCSF, UCLA, USC, Stanford) would be excellent hospitals to obtain a consult. Henry Ford Hospital also has surgeons that specialize in female urology and its complications This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

*keyowrd : vesicovaginal fistula

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