Urinary Fistula Repair Post-Op Recovery Instructions

About Urinary Fistula Repair Recovery

A urinary fistula is an abnormal connection between the urinary tract and another structure — most commonly the rectum (rectourethral fistula), the skin (cutaneous fistula), or the bowel (vesicoenteric fistula). Repair is one of the most complex reconstructions in urology and often follows pelvic surgery, radiation therapy for prostate cancer, or trauma. Recovery is longer and more deliberate than for routine urologic procedures because the repair must heal completely before normal urinary and bowel function can resume.

What sets fistula repair recovery apart:

• Extended urinary diversion. Most fistula patients leave the hospital with a urethral catheter and a suprapubic tube to keep urine completely away from the repair site. Drainage continues for 3-6 weeks depending on the fistula type and tissue quality.
• Bowel rest or diversion. Patients with rectourethral fistulas may have a temporary colostomy to divert stool away from the repair. The colostomy is typically reversed 3-6 months after successful fistula closure.
• Confirmatory imaging before catheter removal. Unlike straightforward urethroplasty, fistula repair recovery includes a cystogram (contrast x-ray of the bladder) at 3-6 weeks to confirm the fistula has closed before any catheters are removed.
• Multidisciplinary follow-up. Many patients are co-managed with colorectal surgery, radiation oncology, or plastic surgery. Expect coordinated follow-up across specialties for the first year.
• Longer activity restrictions. Because the repaired tissue often has prior radiation or scarring, straining, heavy lifting, and sexual activity restrictions extend longer than for standard urologic surgery.

Urinary Fistula Repair — Post-Operative Instructions

What you can expect

• Bruising and some mild bleeding from incision site(s).
• Mild bruising and swelling of scrotum.
• Mild pain in perineum, scrotum, and hips that should improve with activity during the first week after surgery.
• Leakage of urine or bloody fluid from the end of the penis or around the catheter.
• Bladder spasms: can feel like pressure or pain and result in leakage of urine around catheter.
• Nocturnal erections: totally normal and impossible to prevent even with a catheter in place. You can place aquafor or vaseline at the top of the meatus before bed for comfort.

If you had a buccal mucosal graft harvested from your mouth

• Mild swelling and discomfort of cheek that should improve gradually each day.

Dressing Care

• If you have a wrap around your penis, please remove this on the first day after your operation unless told differently by your doctor.

Activity

• No heavy lifting (more than 20 lbs) while catheter in place.
• No driving if taking narcotic pain medication.
• Use stairs infrequently, and take only one step at a time.
• No vigorous activity while catheter in place (shoveling snow, mowing the lawn, raking leaves etc).
• No sexual activity while catheter in place or 3 weeks at earliest.
• If you experience discomfort, reduce activity, and more gradually resume activities.
• Regular light activity and walking is encouraged several times daily. Limit the amount of walking with the catheter in place to no more than several light 15 minute walks per day. Do not be a couch potato.
• Once your catheter has been removed (~3 weeks), you may resume regular physical activity.

For men with a perineal incision

• If you have a perineal incision (between the scrotum and anus), you should sit with your weight shifted onto you buttocks for comfort as needed. You may use an air-filled donut or soft cushion for 4 weeks.
• No activity that involves straddling for 6 months (riding a bike, motorcycle, ATV, horseback riding etc).

Diet

• Drink plenty of fluids (6-8 glasses of water daily).
• Resume regular diet at home.
• If you have a special diet due to diabetes, kidney disease, liver disease etc, you may resume eating when tolerated.

If you had a buccal mucosa graft harvested from your mouth

• Magic Mouthwash as needed for mouth discomfort
• Swish and spit 1-2 ounces (30-60 ml) of mouthwash or half strength hydrogen peroxide and saline solution four times per day until your mouth incision is completely healed.
• You may resume brushing your teeth the day after surgery.
• You may return to your normal diet after surgery as tolerated.
• Begin slowly stretching the mouth once comfortable to help reduce tightness

Medications

• Pain control with 600 mg ibuprofen and 500 mg Tylenol every 6 hours unless your doctor states otherwise. These medications can be staggered so that you can take something every 3 hours.
• Resume all medications you normally took before surgery, unless instructed otherwise.
• Resume Aspirin and blood thinners as directed by your physician.
• If you have any questions regarding your medications, please call our office at 781-744-8420 or call the Lahey Clinic Urologist on-call.

Bowel habits

• Avoid constipation to prevent straining (do not strain when having a bowel movement).
• Increase fiber in your diet
  • Fruits, vegetables, salads
  • Metamucil
• Drink plenty of fluids (8 glasses of water a day)
  • Can add prune or apple juice
• Stool softeners
  • Colace
• Laxatives

  Catheter Care

• You will have a urethral catheter after surgery. You may also have a suprapubic tube (SP tube) that is placed in your bladder and comes out of the lower abdominal wall.
• The urethral catheter will remain in place for 1-4 weeks after surgery.
• If you have a suprapubic tube, the SP tube will generally be removed after the urethral catheter.
• Your catheter(s) should be anchored at all times to either your thigh or calf or abdomen. You will be instructed on how to do this while in the hospital.
• Using soap and water, wash around the meatus at the point of entry of the catheter. Place a small amount of bacitracin (triple antibiotic ointment) around the meatus three times a day until the catheter is removed.
• If your catheter becomes obstructed or falls out contact the office at 781-744-8420 or call the Lahey Clinic Urologist on-call.

Bathing

• Shower daily beginning 48 hours after surgery.
• Gently wash the incision with soap and water, rinse, and pat dry.
• No baths, hot tubs, or swimming for 6 weeks or until after the catheter(s) have been removed

If you have a 1st stage buccal mucosal graft care (you are having a planned 2nd surgery 6 months later)

• Shower every day after the bolster is removed.
• Gently soap up the lower abdominal area and allow the soap and water to wash over the graft.
• Do not scrub the graft with soap and water.
• Gently pat the graft dry and allow to air dry.
• Once the bolster is removed: put thin coat of aquafor over entire graft area 4 times per day until the 2nd surgery (~6 months later).

Common Concerns

• Leakage of urine or bloody fluid from the end of the penis or around the catheter.
  • You may experience pain or pressure in the bladder when this leakage occurs.
  • Check to determine if the catheter is draining properly.
    • If the catheter is draining, these symptoms are not dangerous.
• If you have continuous painful bladder spasms that do not go away or if you have other questions or concerns, call the Lahey Clinic Department of Urology at 781-744-8420.

Reasons to call your doctor

• Incision becomes red, swollen, opens, or has pus-like drainage.
• Skin around your incision becomes warmer than elsewhere.
• Decreased or absent urine from your catheter for 2 hours.
• Catheter becomes dislodged.
• Chills or fever greater than 101 degrees F.
• Nausea and vomiting or inability to keep down fluids.
• Severe pain not controlled by pain medication.

Additional instructions

• Given on a case by case basis. Ask your surgeon if any other instructions are necessary.

For emergent situations call 911 or go to the Emergency Room.

Please feel free to contact us with any other questions or concerns at 781-744-8420.

Fistula-Specific Warning Signs

In addition to the general warning signs above, these symptoms can indicate a recurrent or persistent fistula and require immediate contact with Dr. Vanni's office:

• Passage of gas or stool in the urine — most concerning for a recurrent rectourethral or vesicoenteric fistula.
• Drainage of urine from the rectum or anus — even small amounts during straining or after a bowel movement.
• Persistent leakage of urine from the perineal incision after the urethral catheter has been removed.
• Recurrent urinary tract infections with stool-related organisms (E. coli, Bacteroides, Enterococcus) — your urine culture report may flag these.
• Pelvic pain that worsens rather than improves beyond the first 2-3 weeks.
• For patients with a diverting colostomy: change in ostomy output color, smell, or volume that suggests a urinary connection.

Follow-Up Imaging & Long-Term Monitoring

• Week 3-6: Cystogram (contrast x-ray of the bladder) to confirm the fistula has closed before catheter removal. Some patients require a second cystogram if leakage is still present.
• Week 6-8: Cystoscopy in office to visually inspect the repair from inside the urinary tract.
• 3 months: Office follow-up with uroflowmetry and post-void residual (PVR) to confirm normal bladder emptying.
• 6 months: If you have a diverting colostomy and the urinary repair has remained intact, Dr. Vanni will coordinate with colorectal surgery to plan colostomy reversal.
• 1 year and annually: Symptom check and selective imaging. Most fistula recurrences become apparent within the first 6-12 months.

Your specific imaging schedule may vary based on the type and complexity of your repair. Dr. Vanni will give you a written timeline at your first postoperative visit.