How does bladder fistula do?

summary

Don't believe it. If the patients with bladder fistula don't pay attention at ordinary times, they will get sick and die. Let's talk about what to do with bladder fistula?.

How does bladder fistula do?

First: vesicoenteral fistula: if the lesion is located in the rectum and sigmoid colon, proximal enterostomy can be performed first. After the inflammation disappears, the lesion can be resected and the fistula can be closed, and then the colostomy can be closed. Some scholars suggest that all operations should be completed in one stage, and partial intestinal or appendectomy should be performed for small intestine or appendiceal bladder fistula to close the bladder fistula.

Second: vesicovaginal fistula: small vesicovaginal fistula can be treated by electrocautery, and indwelling catheterization for at least 2 weeks after operation. Aycinena (1977) reported that for some patients with small vesicovaginal fistula, a metal curette was used to scratch the fistula through the vagina to promote the closure of the fistula. Indwelling catheterization for 3 weeks after operation can achieve good results. Large vesicovaginal fistula secondary to obstetric or surgical injury can be repaired by transvaginal or bladder approach. It is difficult to repair the vesicovaginal fistula caused by radiotherapy for cervical cancer due to poor local blood supply. It is impossible to repair the vesicovaginal fistula caused by the direct invasion of the bladder by cervical cancer, so the upper urinary tract often needs urinary diversion, such as ureterosigmoidostomy.

Third: bladder accessory fistula: it can be cured by removing the involved female reproductive organs and closing the bladder fistula.

matters needing attention

1. Help the patient adapt to the change of living habits as soon as possible, explain the performance of fistulas and urine bags, the use method, the possible consequences of improper nursing, etc. when the patient changes body position, pay attention to the position of urine bags, to prevent urine reflux, resulting in urinary tract infection. 2. Keep the room clean, reduce the chance of pollution, guide the patients to open the window regularly every day for ventilation, and keep the clothes and bedding clean. 3. In order to prevent the deposition of urine alkali and obstruction of fistulas, the family members were instructed to inject 50-100ml normal saline into the bladder from the fistulas every day for bladder irrigation. If there was obstruction, sterile syringe could be used for suction and squeezing. If it was still obstructed, 20ml sterile saline could be injected through the fistulas. The obstruction was first flushed into the bladder and then drained out. If the drainage fluid is turbid and there are many necrotic and exfoliated tissues, it indicates that there is infection in the bladder. The bladder can be washed intermittently with normal saline 500ml + gentamicin 240000u twice a day until the urine is clear. 4. It is not suitable for continuous urination through fistula tube. Continuous urination can cause disuse atrophy of bladder detrusor and eventually cause bladder spasm. Generally, urination is performed once every 2-3 hours to maintain bladder self-regulation. 5. Use iodophor cotton ball daily to disinfect the skin of stoma, remove secretions and cover with sterile dressing.