Transvaginal Approach

The principals of TV repair are creation of anterior vaginal flap and a tension-free multilayered closure. The TV approach is the safest and less morbid for patients. It is ideal for fistulas located low in the vaginal wall, or in the bladder neck or proximal urethra. TV repairs do not require the excision of the fistulous tract, and therefore no need to perform ureteral reimplant. For simple, small, and mature fistulas, a transvaginal partial colpocleisis (Latzko procedure) is indicated.11 If the fistulous tract is large, it can be excised, and closure is performed in overlapping layers once tissue is widely mobilized. The bladder is closed continuously with 4-0 chromic sutures, and the pubocervical fascia is closed in two layers (Figure 13-1.1, Figure 13-1.2). More complicated fistulas may require a labial fat or peritoneal pad (Figure 13-1.3).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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