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“Vesico” refers to the urinary bladder and the Vagina is the tubular canal that is a part of the female reproductive system, which extends from the womb to the exterior of the body. A Vesico vaginal fistula is an abnormal tract that is created between the urinary bladder and the vagina; Similarly, a uretero vaginal fistula extends between a defect in the ureters and the vagina. Both these cause urine to leak through the vagina.
The urinary tract is at risk of injury during pelvic operations and complicated child birth. Such injuries may lead to fistula formation, whereby the urine involuntarily leaks through vagina/birth canal. This is a very embarrassing situation for females. So once identified, early treatment is recommended. Initially, when this condition happens immediately after child birth or after a surgical procedure, A tube(catheter) may be inserted to temporarily drain the urine. During this time, the defect or fistula heals automatically. In case this intervention fails, laparoscopic repair is advised. The aim of the repair is to destroy this connection between the bladder or ureter and vagina and seal the defect on the organ, so that the tract doesn’t form again. A Laparoscopic Boari procedure is the name given to repair such a defect on the ureters.
Laparoscopic Boari procedure was first described in 2001 by Fugita et al. This procedure can also be done to operate on ureteral cancer.
How is boari procedure Performed
Through one or more small holes made in the abdomen, the surgeon accesses the abdomen.
The fistula tract between the ureter and vagina is identified. This tract is disrupted using heat.
Then the ureter from which the fistula begins is identified and is cut right above the defective portion.
Since the cut ureter will be shorter, a tongue like structure is created from the bladder itself. This is lifted upwards and wrapped around the remaining part of the cut ureter.
A stent is then placed inside the ureter to prevent it from collapsing.
A drain is placed to remove excess blood from the operated site and a catheter (hollow tube) is placed to drain the urine temporarily.
Catheter and drain are removed in 2 days, the stent in 6 weeks.
It is a socially embarrassing situation for women when urine leaks out through the vagina. Moreover, they will be prone to vaginal and urinary tract infections. Hence early treatment calls for a better quality of life.
Life after boari procedure
The woman can return to normal activities 2 weeks after surgery. However, follow up check ups will be advised by the surgeon for stent removal and to confirm proper healing of the area were surgery was performed.
boari procedure FAQ
This can be a sickeningly difficult problem for a patient, with continuous leak of urine through the vagina. As the vagina has no sphincter to control it, the patient will be wetting her underclothes constantly, that she will smell like a mobile urinal, This is one of the most troublesome problems for a woman, after a hysterectomy.
Also a little bit of fat is brought from above to plug the gap between the 2 organs to prevent the tract from forming again.
boari procedure Specialists
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. Ilamparuthi Chennakrishnan
GENITO- URINARY SURGEON
M.B.B.S., M.S. (General surgery), M.Ch. (Urology), D.N.B. (GUS), F.I.C.S.