This position brings the anterior vaginal wall into view and allows excellent exposure for fistula repair. In addition to patient positioning, other maneuvers can significantly improve the surgeon's ability to see the fistula. Here we see stay sutures placed in the labia majora. An Auvard weighted vaginal speculum is placed posteriorly, and ureteral catheters are placed in the ureters. For fistulae located closer to the bladder neck, a metal catheter or uterine sound inserted via the urethra can be used to distract the defect down into view.
Good lighting is also very important.
The Addis Ababa Fistula Hospital has the operating tables oriented so that light coming in through the windows helps to illuminate the operative field, even if electrical power is lost. Be creative and do what you can. For problems or questions regarding this web contact the webmaster .