New Challenges

It seems like everyday brings a new set of challenges, either in the hospital or in daily life. One of my new challenges has been learning how to repair vesicovaginal fistulas. For the non-medical people. a vesicovaginal fistula is a hole connecting the bladder to the vagina. These are caused by prolonged labor, the pressure of the baby’s head against the bladder or the rectum causes ischemia (lack of blood flow) and destruction of the tissue. Sometimes this just causes scarring, but it also frequently causes a hole to form in between the bladder and the vagina, and sometimes also between the rectum and vagina.

These women then spend their lives with urine leaking out constantly. Often their husbands divorce them and their families disown these women, because they are damaged and smell like urine all the time. The surgery to fix the fistulas can be very difficult because the tissue can be very scarred, the urethra can be destroyed, the ureters can be involved. The recurrence rates after repair are quite high because of this.

A visiting surgeon taught me how to do the repairs and since June I’ve done about 30-40 repairs. When the repair is successful, the surgery is very rewarding. These are some of the happiest patients I have, even though you can’t tell in the photo up above. As soon as the camera comes out, they stop smiling, because here, you’re supposed to look serious for photos. They start smiling again as soon as the picture is taken.