I saw my gynecologist last Tuesday for my 6 1/2 week post-hysterectomy check-up. By that point, I was also 19 days symptom-free from the vesicovaginal fistula (VVF) complication I had sustained, that ended up spontaneously healing after two weeks.

My gynecologist gave me a clean bill of health and said I could return to normal activity. Yay!

I mentioned some minor pain I’d been experiencing, particularly when I leaned over to my left side. On inspection, he noted that I had a small amount of scar tissue that was probably causing it. Like a splinter, something this small can actually cause noticeable pain, and it’s very normal post-hysto. I asked if the scar tissue was where the fistula had been, and he said it was in the same general area. (It’s important to note that he could never actually see the fistula because it was small. Only the urologist had seen it, during the cystoscopy he performed.)

While I was lying on my back, legs spread, he pulled out a thin stick and told me it had silver nitrate on the end. I’d remembered hearing that this was sometimes used post-hysto to help stop bleeding. I asked what it did, and he told me that silver nitrate causes a cell reaction with scar tissue. Given my position, and trusting my doctor, I asked no more questions, though in hindsight I wish I had… He applied the silver nitrate and sent me on my merry way.

By the next morning, I was leaking urine again—after almost 3 weeks dry! Very distressing. I did some reading about silver nitrate and learned that it cauterizes, or burns, tissue. The “excess scar tissue” was actually my healed over fistula, and the silver nitrate apparently burned a hole through to my bladder, opening the fistula again!

My gynecologist called me later that day and seemed a bit puzzled that such a small amount of silver nitrate could have opened the fistula again. But there was no doubt about the nature of the bodily fluid I was leaking: definitely urine.  It seems likely then that the tissues healed over the fistula were not very strong or thick yet, which probably isn’t too surprising given the short amount of time I’d been symptom free.

The good news is that I’ve been leaking much less than when the fistula first appeared, and this gives me hope that I will once again heal. In fact as I write this, I’ve had my most leak-free day since Wednesday.

What I am very worried about though is that we don’t have a clear picture of how things have healed in my bladder. I am scheduled for a cystoscopy on May 12, and I’m nervous about the procedure. At my first cystoscopy, the urologist tried to poke the cystoscope through the fistula tract to see how large it was. If I’m symptom free on May 12, will he try to poke around again? Like my gyncologist, will he inadvertently break the bladder dam that my body has been working hard to re-build? Will he see that the bladder side hasn’t healed well? Will he recommend another horrible turn with a catheter? Will he recommend repair surgery? Will I always have to worry about the strength of that healed tissue?

Will I ever feel secure that I won’t leak again??

I find myself frustrated at my lack of knowledge about the anatomy of the bladder and vaginal wall. I have to put my trust in my doctors, neither of whom have very much experience with VVF. Because VVF is not common, no one around here has experience treating it. The urgynecologist in Vancouver does, and he told my gynecologist I would need surgery. Maybe I still do. It’s too early to know, I guess. The only thing I can do now is take very good care of myself physically and give my body a chance at a second attempt at healing. I’m on limited fluids and limited activity. I’m hopeful, but I’m also more cautious then I was a few weeks ago.