This case involves a 63-year-old female patient with abnormally heavy vaginal bleeding that underwent a laparoscopic-assisted vaginal hysterectomy. Following the operation, the patient had urinary incontinence and was taken to the operating room with the diagnosis of continuous urinary leakage consistent with a fistula. She had a subsequent procedure for repair. After the procedure, the patient continued to have similar symptoms and presented to a urogynecologist. She was taken to the operating room once again for a robotic-assisted closure of a vesicovaginal fistula.
Question(s) For Expert Witness
- 1. Please describe your background in urogynecology.
- 2. When a patient has continuous urinary incontinence following a hysterectomy, what workup is recommended?
Expert Witness Response E-009213
I am a urogynecologist and board-certified subspecialist in female pelvic medicine and reconstructive surgery at an Ivy League institution with 13 years of clinical experience. I am the current president of our national subspecialty society and have national and international recognition in our field. Our practice is the primary referral practice for all vesicovaginal fistulas in our geographic region. I have given lectures regarding fistulas and repairs in the past. I am very familiar with and have performed the Latzko procedure. If a patient has continuous urine leakage following a hysterectomy, the first thing to do is to rule out a fistula. This includes a thorough physical exam to identify the source of leakage, whether urine leakage is from the urethra, or from the vagina. There are some additional office procedures that can be performed, and imaging studies should be ordered once a fistula is seen to evaluate possible other injuries and the extent of the fistula. The first attempt at fistula repair is usually the most successful and thus should be performed by someone experienced.