Ureterovaginal fistula repair

The main target of ureterovaginal hernia repair is low ureterovaginal fistula. After the pupil occurs, after active anti-infection and improvement of the systemic nutritional status of the patient, some ureterovaginal fistula can usually heal automatically in 5-8 weeks. Therefore, pupil repair is generally considered after 8 weeks. The anastomosis of the ureter and the bladder wall or the bladder valve is poorly healed, and urinary fistula is formed again, mostly due to excessive tension after anastomosis, poor blood supply or infection. After ureteral bladder anastomosis, it should be guaranteed no tension; pay attention to ureter and bladder blood supply during anastomosis, do not excessive damage, affect blood supply. Strengthen anti-infection and maintain patency of the catheter after surgery. Once urinary fistula occurs, conservative treatment is feasible. After 1 to 2 months, it can often heal itself. Treating diseases: female urinary fistula Indication Low ureterospasm. Preoperative preparation Active anti-inflammatory treatment. Surgical procedure Ureteral vaginal fistula repair, ureteral bladder implantation. The methods include a bladder submucosal tunneling method and a bladder flap method. (a) bladder submucosal tunneling 1. Exposing the ureter: After opening the abdomen, open the pelvic peritoneum on the affected side, cut it over the ureteral lesion, ligature the distal end, insert the proximal urinary catheter into the renal pelvis for the proximal end, and have the ureter with a tortuous Free so that the length is sufficient to match. 2. Submucosal tunnel: the posterior part of the free bladder base, the bladder was cut open near the ureter, and the incision was extended to 2 to 3 cm above the ureteral orifice. A submucosal sneak is separated from the edge of the bladder incision to the bladder neck to make it a tunnel, 2 to 3 cm long and about 1 cm wide (to pass the ureter and stent). The bladder mucosa was cut open near the inside of the original ureteral orifice. 3. Ureteral implantation: At the same time as the separation of the mucosal forceps, a No. 8 catheter is taken out and pulled out of the artificial tunnel. The catheter is connected to the ureter stent by a wire and pulled into the bladder. The distal end of the ureter was cut open, and the bladder mucosa was sutured with an absorbable line to remove the catheter and the stent was retained. 4. Suture the bladder incision: the ureteral stent was sutured with a length of about 10 cm and placed in the bladder for future removal of the ureteral stent. The bladder wall incision was layered and sutured. The outer membrane at the entrance of the ureter and the outer layer of the bladder wall were sutured 3 to 4 needles, and the ureteral anastomosis was placed next to the catheter drainage, and the abdominal wall incision was sutured. (B) ureteral bladder anastomosis 1. Treatment of the ureter: cut off the ureteral lesion, ligation of the distal end, proximal insertion of the ureteral catheter to the renal pelvis. 2. Bladder flap formation: separation of the anterior wall and bottom of the bladder. According to the length of the ureteral defect, a trapezoidal valve is formed on the anterior wall of the bladder, and the base is located at the bottom. The length of the flap is about 5-6 cm, the bottom width is 4-5 cm, and the top width is 3-4 cm. 3. Submucosal tunnel formation of the bladder valve: a submucosal tunnel is formed at the center of the end of the bladder flap, which is about 2 to 3 cm long and about 1 cm wide. The ureter and its catheter were pulled into the bladder flap through the tunnel, and the ureteral stump was sutured intermittently with the bladder mucosa, and the ureteral catheter was fixed with this line. The ureter should be tension-free after anastomosis. 4. Stitching the bladder flap: suture the bladder flap with a respirable suture continuously, so that it is tubular. The muscle layer was reinforced by intermittent suture. The adventitia of the ureter into the bladder is intermittently reinforced with the end of the bladder flap. In the field, the hose was drained and the abdominal wall incision was sutured.

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