This Saturday our last fistula patient was discharged to "the village."  The village is a temporary housing facility behind the hospital for patients awaiting an operation, waiting to be examined before being discharged to home, or for those who have "incurable" fistulas and no other place to go.  It is also a place to be trained in a vocation (i.e. knitting) to help with re-integration into their communities.

I have enjoyed the opportunity to have a small part in the care of these women. Most of the care has been standard post-operative fare, but  I have learned a few new things.... warning, the following story contains medical details some of you may want to skip (but no graphic images, etc.)

On Monday, we took out all remaining urinary catheters. There were two patients who had "anterior repairs" for urinary incontinence. The departing surgeon's instructions for those patients were: "Leave the catheter in 7-10 days, then remove it. If patient can't void, replace catheter for 7-10 days. Then, if she still has urinary retention, don't replace the catheter. Instead, dilate the urethra with the Hegar dilators, first with #5, then #6, then #7, maybe #8 if she still can't void." He repeated those exact instructions multiple times as we rounded on each patient with an anterior repair.  Pretty straightforward, right? That's what I thought.

On Monday afternoon, two women with anterior repairs couldn't urinate after their catheters were removed the second time. Next step...to the clinic for dilation. I prepped, draped, and opened up the set of sterile dilators. This is what I expected to see:

Hegar dilators

This is what I saw:

NOT Hegar dilators

Hmmm...now what?! To be safe, I decided to do a little investigation while the nurses took a quick lunch break. Turns out, the hospital doesn't currently have Hegar dilators.  What they do have is a cystoscopy obturator and the above instruments.  With a little additional internet research, I discovered that those instruments are called Van Buren sounds and are indeed used for urethral dilation. After some quick calculations to convert the French measurements into millimeters (divide French by pi- 24 Fr would be like a #8 Hegar), I proceeded with gentle urethral dilation. Both procedures went smoothly. :)

Flexibility...a key to operating anywhere!