Vesico vaginal fistula (VVF) is an abnormal opening between the bladder and the vagina; a rare complication of prolonged labour or obstructed labour when the tissues of the bladder are devitalized by prolonged pressure of the fetal head.
Patients Who are At High Risk of Developing Vesico Vaginal Fistula
- Patient with congenital malformations of the reproductive tract.
- Patient that had criminal abortion due to perforating injury.
- Patient with difficult delivery due to sloughing associated with prolonged pressure of the fetal head on the bladder as in cephalopelvic disproportion.
- Patient with prolonged labour.
- Patient that has early sex or marriage
- Patient that undergoes radiotherapy for carcinoma of the cervix leading to radium injury.
- Patient that has invasion or erosion from malignancy involving either the bladder or the vagina.
- Patient that undergoes cesarean section, symphysiotomy, forceps delivery and vacuum extracting due to injury to the ureter.
Pre-operative Nursing and Medical Management of a Patient With Vesico Vaginal Fistula
Admission;
- Admit patient in the surgical ward and prepare her for surgery.
- Take history of her condition.
- Encourage bed rest.
Position:
- Encourage any position comfortable to her.
- Place patient in a semi-fowlers position to facilitate drainage and prevent infection associated with uterine stagnation.
Psychological Care:
- Reassure the patient and relations bearing in mind that the family may be experiencing some denial or other stage of grieving to allay her anxiety.
- Encourage her to discuss her feelings.
- Be available too patient, offer her emotional support and help her develop effective coping strategies.
- Listen to the concerns of patient and significant others and provide support.
Observation:
- Observe the general well being of the patient.
- Observe the vital signs – check blood pressure, temperature, pulse and respiratory rate every fifteen minutes and record.
- Monitor intake and output.
- Perform physical examination; inspection and palpation to confirm diagnosis.
Feeding:
- Re-hydrate patient with prescribed intravenous fluid to restore hydration.
- Nil by mouth to keep the stomach empty and prevent aspiration.
- Pass naso-gastric tube, aspirate half hourly to decompress the stomach, if need be and prevent vomiting and aspiration.
Investigation:
- Obtain blood samples for complete blood count, grouping and cross matching.
- Encourage and prepare patient for some other investigations such as X-ray
- Take urine for urinalysis.
Consent Form Signing:
Consent for operation obtained from patient after explanation of the surgery to give legal backing to the surgeon, anaethetist and protect patient from unauthorized procedure.
Prepare Patient For Surgery:
- Bed bath patient if she can not go to the bathroom.
- Shave the patients’ pubic region.
- Give enema to empty bowel.
- Give pre-medication as ordered.
- Remove dentures and jewelries before taking patient to the theatre.
- Maintain adequate personal hygiene.
- Accompany patient to the theatre with case note, laboratory result, X-ray and ultrasound results.
Intra-Operative Care
Make up post operative bed with resuscitation tray, vital signs tray, infusion stand and suction machine in readiness for her reception.
Post-operative Nursing and Medical Management of a Patient With Vesico Vaginal Fistula
Bladder/Bowel Care:
- Monitor/maintain the continuous ladder drainage for up to 14 days to rest the bladder and therefore prevent strain on the repaired site.
- Ensure copious fluid intake to flush the urinary system.
- Place patient on low residual diet.
- Administer prescribed medication.
Psychotherapy:
- Continue to reassure her and encourage her to express her feelings.
- Use diversional therapy e.g. television
Physical Care:
- Turn her every two hours and give daily bed bath.
- Encourage her to perform exercises such as deep breathing exercise, range of motion exercise e.t.c
Nutrition:
- High protein diet.
- Limit diet to liquids for the first five days and low residue to limit defecation and prevent strain from suture line.
- Encourage copious fluid intake.
Advice on Discharge:
Advice her on the following;
- To avoid strenuous activity of lifting heavy objects, rapid walking or dancing.
- To eat foods reach in proteins and vitamins to aid healing.
- To avoid sexual intercourse for six weeks.
- To report signs of infection early and clean the perineum gently.
- To keep regular follow-up appointments.
Complications of Vesico Vaginal Fistula
- Excoriation and inflammation of vulva.
- Social isolation.
- Urine incontinence.
- Offensive odour.
- Disturbances of menstruation.
- Infertility due to scar formation.
- Adhesion due to inflammation.
Health Education Of A Community on Measures to Prevent Vesico Vaginal Fistula
- Greet community members and introduce self.
- Establish a common language of communication.
- Arrange the best venue and communicate the time and venue to members.
- Make sure the participants are comfortable.
- Assess their knowledge on the prevention of vesico-vaginal fistula
- Introduce the topic viz prevention of vesico-vaginal fistula.
- Explain the aims and objective of the talk:
-
- To learn the meaning of vesico vaginal fistula.
- To identify the causes/predisposing factors to vesico vaginal fistula.
- To know the preventive measures to VVF.
- To encourage them to participate in the prevention of VVF.
- Present talk by stressing on the following;
(a). define vesico vaginal fistula as an abnormal opening between the urinary bladder and the vagina.
(b). List the causes/predisposing factors to VVF:
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- Criminal abortion.
- Prolonged labour/difficult labour.
- Early sex.
- Early marriage.
(c). Enumerate the preventive measures for VVF:
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- Performing cesarean section to prevent prolonged labour.
- Discouraging early sex/marriage.
- Avoid criminal abortion.
(d). Encourage them to participate in prevention of VVF as follows:
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- To give their children good parental upbringing.
- To deliver their children in a well equipped hospitals.
- Summarize all that you have taught them, by stressing more on the important points.
- encourage them to ask question and answer them properly.
- Ask them to identify the causes and preventive measures to VVF they know.
- Thank them for listening.
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