vesicocervical fistula repair

The bladder cervix is the bladder sac that leads to the cervix, the urine continues to flow from the cervix, and there is no pupil on the vaginal wall. Sometimes accompanied by a anterior cervical laceration. Treatment of diseases: bladder spasm Indication Most of the pupils are not large, and there are not many scars on the vaginal wall. As long as the cervical activity can pull out the vaginal opening, it can be repaired by the vagina. If there is a cervical laceration, it can be repaired at the same time. Contraindications Systemic or local acute and chronic inflammation, diabetic patients must be treated after or after treatment. Preoperative preparation 1. Urine dermatitis with 1:1000 benzalkonium or potassium permanganate bath 2 times a day, external anti-inflammatory ointment. Change the shade pad until the inflammation disappears. 2. Cystitis and vaginitis should be supplemented with sensitive antibiotics. Partially washed once a day with nitrofurazone or boric acid solution until the inflammation and redness completely disappeared, and the urine culture was negative. 3. Each enema is given 1 time before and on the morning of the operation. Shave the pubic hair and wash the vulva with soapy water. 4. Administration before anesthesia is carried out in accordance with the anesthetic regulations used. Several days before surgery, estrogen such as Premarin can be used as appropriate to promote the healing of vaginal mucosa. However, there are many people who do not advocate the addition of sex hormones. 5. In addition to the commonly used vulvovaginal surgical instruments, surgical instruments must be prepared for urinary fistula repair with long handle thin, straight, curved small scissors, small pointed blades, small scorpion-shaped pointed blades, sickle catheters, female metal catheters, Ureteral catheter, small suction tube (front curved tube), well-lit spotlights, etc. The needles and stitches are complete. Surgical procedure Take the frog-style prone position. Incision The cervix is pulled down to the vaginal opening, and the probe is used to penetrate the pupil into the bladder from the cervical canal to detect the height and size of the pupil. The vaginal mucosa was cut by a 3 cm incision from the cervix and bladder junction, and the vaginal mucosa and the bladder wall were separated upward to expose the bladder wall pupil and the cervical wall pupil, and the bladder wall was peeled outward to about 2 cm around the pupil. And push the bladder wall up 1.5cm to expose the anterior wall of the cervix. 2. Stitching The first layer of the bladder pupil was sutured with a 3-0 needle-absorbable suture or an intestine fine needle. Test leaks, such as no leakage, intermittently suture the bladder muscle wall (second layer), covering the pupil suture (two layers of needles staggered). If there is a anterior cleft lip injury, cut the cleft scar with a 2-0 absorbable suture or a suture interrupted suture. A transverse shallow curved incision of the vaginal mucosa was then sutured with a 2-0 absorbable suture or gut to cover the entire wound. complication If strictly implemented in accordance with the principles of surgery, success is still the main outcome. In case of infection or bleeding, the treatment is the same as vaginal surgery. If the wound is split, the operation fails, and the infection is treated, and only after the inflammatory bleeding stops, consider the subsequent operation. In the near future, heavy sewing will not help.

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