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Vesicovaginal Fistula Repair Case Study #2
Patient flies from Hawaii to Atlanta after 3 Failed Vesicovaginal Fistula Repairs
Fistula Symptoms: Urinary leakage through vagina (July 2008)
Initial Cause of Fistula: Complete Abdominal Hysterectomy with a severe case of endometriosis
Failed Attempt to Repair Fistula: 2x Vaginal approach – failed / 1x vaginal approach with glue - failed
Just 3 weeks after this 38-year-old patient from Hawaii had a total abdominal hysterectomy with a severe case of endometriosis, she developed a vesicovaginal fistula. Five months later in December 2008 her Urogynecologist first attempted to repair it through the vaginal approach, shortly after new years she discovered leakage from the vaginal area. Three months later, she was given an alternative of proceeding with a subsequent repair through the abdominal route with a placement of an omental flap versus a repeated attempt through the vaginal route. She refused the abdominal route and went ahead to re–attempt the vaginal route again in March of 2009. After the March surgery a cystogram revealed no leakage or signs of a fistula and catheters were removed. Two weeks after, she developed another recurrence and another cystogram confirmed there was definitely a leakage in the vaginal area. The patient and her urogynecologist discussed the possibility having it repaired via the abdominal route, however the patient strongly wanted to have it repaired laparoscopically, but her adhesions were a concern for her urogynecologist. The patient also did not want another laparatomy procedure done due to the experience of having a difficult time recovering from the total abdominal hysterectomy surgery.
The patient then searched online and found Dr. Miklos. On October 2009 she emailed Dr. Miklos her questions and concerns and was very surprised to receive a quick response from him. “Dr. Miklos was very helpful in answering and reading my medical notes even if I wasn’t a patient of his at that time.” At the time this patient was communicating with Dr. Miklos, her urogynecologist in Hawaii offered to try a less invasive surgical procedure that would involve trying to repair the fistula with glue. Per the patient, it was worth a try before flying out to Atlanta. In November 2009 she, once again, attempted to repair her fistula via vaginal route with glue, which at the end of the week the fistula recurred and she was faced with another disappointment.
With all 3 failed surgeries, she asked her urogynecologist if she has heard about Dr. Miklos, which she did. Her Urogynecologist was very supportive of her seeing Dr. Miklos and felt that having the surgery completed successfully laparoscopically would be greater with Dr. Miklos. In March of 2010, she traveled to Atlanta to have her fistula repaired laparoscopically by Dr. Miklos.
Testimonial from Patient:
When I met Dr. Miklos, I immediately felt comfortable with him as he explained the procedure in detail and answered any questions my husband and I had. I felt he was very confident in his work, which made me even more comfortable and trusted him to perform the vesicovaginal repair. Today, I’m not dealing with anymore urinary pads, don’t have to worry about having an accident, and I’m able to do my normal activities. I live in Hawaii and haven’t been able to swim or jump into a Jacuzzi, now I can. I am so very, very happy I have my life back. I thank God that I was blessed to have met and have been treated under the care of Dr. Miklos & Dr. Moore and his wonderful and outstanding nursing and office staff, they are the BEST! I would definitely recommend these doctors even if you have to travel thousands of miles like me. It was worth it!!" - click here for the full testimonial.
Here are some of the pictures taken during the surgery:
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| Picture 1--shows opening the fistula tract with the bladder above and the vagina below | Picture 2--shows the separation of the stent and the fistula; the hole above is the bladder and the one below is the vagina | Picture 3—shows the hole in the bladder after cutting away the fistula scar of the bladder (now it appears larger than before) |
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| Picture 4—shows closing the edges of the bladder using a suture and needle | Picture 5---shows the placement of our 6th suture (out of 7) closing the bladder hole in an area of less than 1 inch (this is the first line of closure, we reinforced this closure with a second layer of sutures) | Picture 6—shows a bladder full of water testing the integrity of our surgical repair. We tested the tightness of the repair only after doing a two layer closure on the bladder. |