Portal-zdrowia.pl

Portal medyczny o zdrowiu

Choroby i dolegliwości Porady Specjalistyczne

Powikłania po zabiegu ginekologicznym

Doctor and Patient sitting on the desk .
Doctor and Patient sitting on the desk .

Przetoka pęcherzowo- pochwowa to jedno z najczęstszych powikłań operacji i zabiegów ginekologicznych w obrębie miednicy mniejszej. Często jest mylona z nietrzymaniem moczu i dlatego należy ona do najbardziej uciążliwych i stresujących przypadłości.
Powoduje ona nie tylko pewien dyskomfort, ale stanowi przyczynę bardzo częstych i nawracających infekcji intymnych. Długotrwałe problemy z tym specyficznym „nietrzymaniem” moczu powodują wyobcowanie chorej, uniemożliwiają jej normalne funkcjonowanie w społeczeństwie.

Większość przetok powstaje w wyniku uszkodzenia pęcherza moczowego spowodowanego  przedłużającym się porodem fizjologicznym, urazami okołoporodowymi, cesarskim cięciem, porodem operacyjnym przy użyciu kleszczy. Mogą pojawiać się także przetoki spowodowane zakażeniami, wadami wrodzonymi, chorobami nowotworowymi narządów rodnych.

Głównym objawem przetoki pęcherzowo- pochwowej jest wyciek moczu z pochwy, który z czasem może się powiększać i stanowić coraz większy problem.  Kobiecie towarzyszą także bóle brzucha, niedrożność jelit, czasami krwiomocz. Objawy najczęściej występują zaraz po zabiegu, nawet jeszcze w czasie hospitalizacji, ale zdarza się że pojawiają się nawet kilkanaście- kilkadziesiąt dni po nim, jeżeli utworzył się także krwiak blokujący ujście moczu.

Rozpoznanie przetoki odbywa się poprzez wprowadzenie barwnika za pomocą cewnika do pęcherza moczowego i obserwację czy zabarwiony mocz nie wypływa z pochwy. Czasami niezbędna jest bardziej złożona diagnostyka optyczna- uretrocystokopia, pozwalająca na odnalezienie miejsca przecieku. Zastosowanie tej metody pozwala na lepsze dostosowanie metody leczenia. Warto wiedzieć, że najczęściej stosowane badania USG i TK nie są w tym przypadku skuteczne.

Istnieją cztery typy przetoki pęcherzowo- pochwowej ze względu na jej odległość od ujścia cewki moczowej. Z typem 1 mamy do czynienia gdy jej otwór znajduje się minimum 3,5 centymetra od ujścia cewki, z typem 2 gdy otwór umiejscowiony jest w odległości 2,5 do 3,5 centymetra. Typ 3 to odległość w granicach 1,5 do 2,5 centymetra, a typ 4 to odległość otworu przetoki mniejsza niż 1,5 centymetra od ujścia zewnętrznego cewki moczowej.

Leczenie tej przypadłości najczęściej opiera się na zabiegu chirurgicznym, a wybór odpowiedniej metody zależy w znacznej mierze od umiejscowienia przetoki, wielkości przecieku, pojemności pęcherza moczowego, budowy anatomicznej kobiety oraz samej przyczyny przetoki oraz wieku chorej.

Lekarze specjaliści najczęściej decydują się na zabieg przezpochwowy, ze względu na to jego mniejszą inwazyjność oraz to, że pozostawia on mniejsze blizny. Jeżeli jednak przetoka ma charakter bardzo rozległy i trudno umiejscowiona, operację można wykonać poprzez otwarcie pacjentki, a więc przez powłoki brzuszne. Udany zabieg przywraca nie tylko prawidłową budowę narządów, ale uwalnia kobietę od przykrych i wstydliwych dolegliwości, które często uniemożliwiały normalne funkcjonowanie wśród innych osób. Dlatego nie należy odwlekać decyzji o jak najszybszym zdiagnozowaniu problemu i podjęciu niezbędnego leczenia.

Polecani lekarze ginekolodzy z Warszawy: http://www.medica2000.com.pl/specjalisci/ginekolodzy/

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