Most impoant pa of post operative management of vesico vaginal fistula is: September 2009
Ans. C: Continuous bladder drainage Postoperative details Bladder drainage: continuous bladder drainage postoperatively is vital for successful vesicovaginal repair. A large-caliber catheter minimizes the potential for catheter blockage by blood clots, mucus, and calcaneus deposits. - Type and duration of catheter drainage: For fistulas involving the lower poion of the bladder trigone, bladder neck, or urethra, transurethral bladder catheters should not be used. A large suprapubic catheter is preferable to minimize excess tension on the suture line and to ensure nonobstructed continuous drainage. In posthysterectomy VVF repairs, both transurethral and suprapubic catheters may be placed.Surgeries to repair pelvic radiotherapy-associated VVFs require longer periods of drainage. Acidification of urine to diminish risks of cystitis, mucus production, and formation of bladder calculi is a consideration for patients with an indwelling catheter. Vitamin C or methenamine mandelate can be used. Estrogen replacement therapy in the postmenopausal patient may assist with optimizing tissue vascularization and healing. Control of postoperative bladder spasms: Urised iseffective for control of postoperative bladder spasms. It is a combination of antiseptics (methenamine, methylene blue, phenyl salicylate, and benzoic acid) and parasympatholytics (tropine sulfate, and hyoscyamine sulfate). Antibiotic therapy: Close follow-up and prompt evaluation for any urinary tract infections and antibiotic therapy, when indicated, are mandatory. Minimizing Valsalva maneuvers: Stool softeners and a high-fiber diet postoperatively minimize Valsalva maneuvers in the patient. Examinations: Avoid pelvic and speculum vaginal examinations during the first 3 months. Pelvic rest: Prohibit coitus and tampon use for a minimum of 3 months.
Complete bed rest
Acidification of urine
Continuous bladder drainage
Antibiotic