The urinary bladder
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
A ureteric stent is passed up the ureter on the affected side and the anterior bladder wall is exposed through a suprapubic incision. The bladder is incised in the midline and the diverticulum is packed with a strip of gauze. The neck of the diverticulum is separated from the ureter and, when the pouch is free, it is severed from the bladder. The resulting defect is closed in a single layer with 2/0 absorbable sutures. A suprapubic catheter is left in place and an extravesical drain is inserted. An alternative method, if the sac is densely adherent, is to carry the incision in the bladder down to the rim of the diverticular orifice, then to detach the diverticulum together with its fibrous rim. The incision in the bladder is closed and the diverticulum left in position with a corrugated drain placed into it for 2-3 days. The track fibroses rapidly after removal of the drain. If bladder outlet obstruction is present, prostatectomy should be carried out at the same time as the diverticulectomy, using any appropriate method (transurethral resection of the prostate [TURP], laser or open).
Abdominal and Genitourinary Trauma
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
The genitourinary system comprises retroperitoneal structures, pelvic structures and external genitalia. Management of injuries to the retroperitoneum is covered in previous paragraphs. Investigation and management of lower urogenital trauma require specialist referral.60 Trauma patients may need a urinary catheter, but in the presence of blood at the meatus this should be attempted once by an experienced clinician. The risk of uretheral injury means that if a catheter cannot be passed, then a suprapubic catheter should be considered. A CT cysto-gram and retrograde urethrogram should be performed if there is suspicion of urethral or bladder injury such as frank haematuria following catheterization or failure to pass a catheter.61 Dilute contrast can be instilled via a catheter, which is then clamped, the patient then has a CT scan; this is typically performed to confirm a diagnosis suspected on a trauma CT.
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Postoperatively, the vagina is packed with an antibiotic-impregnated gauze for several hours. Urethral and suprapubic catheter drainage is recommended until the urine is clear of blood. The urethral catheter may then be removed to minimize mucosal irritation at the site of repair. Oral antibiotics should minimize the risk of infection. Bladder spasms have been postulated to compromise healing of the repair (88), and should be treated. Oral or topical estrogen has been demonstrated to promote healing (89). Cystography is performed at two weeks to document complete healing of the fistula, followed by catheter removal.
Update on vesicovaginal fistula: A systematic review
Published in Arab Journal of Urology, 2019
Ahmed S. El-Azab, Hassan A. Abolella, Mahmoud Farouk
Most VVFs are accessible via a transvaginal approach. The vaginal approach is associated with less morbidity, less blood loss, less burdensome for patients, and lesser hospital stay than the abdominal approach. Through the anterior vaginal wall, the vagina is dissected off of the bladder followed by a multilayer closure. Before we start the procedure we insert a ureteric catheter. To ensure bladder drainage, we place both a urethral and suprapubic catheter. We usually use only a wide-bore urethral catheter in cases of straightforward obstetric VVFs [28]. An alternative approach is the Latzko technique. The Latzko technique may be typically indicated for proximal post-hysterectomy VVF. The technique consists of a circumferential ellipsoid incision around the VVF, with wide mobilisation of the vaginal epithelium in all directions. The vaginal epithelium around the VVF site is excised and the fistulous tract is closed. The repair is reinforced by a layer derived from the perivesical tissue. A modified colpocleisis is performed, with several layers of absorbable sutures from the anterior to posterior vaginal wall obliterating the upper vagina. The Latzko partial colpocleisis procedure is an alternative technique to traditional vaginal repair. Shortening of the vaginal canal can occur but rarely affects sexual function. However, caution should be exercised when considering it in sexually active females [29].
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
The essential steps of undiversion of the ileovesicostomy are as follows; exposure of the bladder and ileovesicostomy via laparotomy, takedown of the stoma, detubularizing the limb of bowel on its antimesenteric border, creation of a “cup patch” using the approximately 15 cm ileal segment that previously served as the ileovesicostomy, and finally, anastomosis of the patch to the bivalved bladder to complete the augmentation ileocystoplasty (Figure 2). The fascial defect at the stoma site is closed. If the ileovesicostomy segment is not suitable for bladder augmentation, it may be resected and a new segment of ileum could be harvested to complete the bladder augmentation. This was not necessary in these our series. A temporary 24 French suprapubic catheter was left in place in all patients for three to four weeks to aid in healing. During this period, the catheter was capped for increasing periods allowing for temporary bladder filling. This bladder cycling protocol continued until capping times reached four hours per cycle. At this time, the suprapubic catheter was left capped, and intermittent catheterization was instituted. Initially, the suprapubic catheter was kept in place to allow bladder drainage if intermittent catheterization was unsuccessful. In all patients, the suprapubic catheter was removed after 72 h of successful intermittent catheterization.
Post-coital vesicovaginal fistula with prior consensual intercourse and after normal vaginal delivery
Published in Journal of Obstetrics and Gynaecology, 2022
Mukesh Chandra Arya, Ajay Gandhi, Ankur Singhal, Yogendra Shyoran, Mahesh Sonwal, Rakesh Singh
Under a spinal anaesthesia, the patients were placed in the lithotomy position. Cystoscopy (19 F) revealed a single supra-trigonal fistula (size 4 to 5 cm) well away from the ureteric orifices. Both the ureters were cannulated with 5 F ureteric catheters. The bladder was approached through midline infra umbilical incision. A trans-vesical repair of VVF was done with interposition of the pedicled omental flap. A suprapubic catheter (SPC), abdominal drain (20 F) and Foley catheter (18 F) were placed. The ureteric catheters, drain tube and per urethral catheter were removed on day 3. They were discharged with SPC in situ. They voided well after removal of SPC on day 14. Case 2 had twin vaginal deliveries nine months after repair, despite advice to abstain from intercourse for three months. She probably conceived just after surgery.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Birth Defect
- Bladder
- Surgery
- Urine
- Abdominal Cavity
- Urethra
- Urinary System
- Cancer
- Kidney Stone Disease