Through a first-of-its-kind surgical procedure, a Lufkin urologist has given quality of life back to an Angelina County woman and hopes to provide others with the same kind of relief. Using an innovative procedure, an amniotic membrane and robotic technology at St. Luke’s Health Memorial, Dr. David Price, a board certified urologist, successfully repaired a complex bladder problem in a way no one has done before.
After being diagnosed with cervical cancer in 2014, Julia Hardin, 66, suffered for more than six months from constant, uncontrollable urinary incontinence following a complete hysterectomy, chemotherapy and radiation. The embarrassment, odor and stress were taking a toll on the Huntington woman.
“I didn’t want to go anywhere; I couldn’t go anywhere because I was always worried about leaking,” Hardin said. “I have a son, and he’s into football and taekwondo. I wanted to go, sit and watch him like any other mom, but I was always self-conscious.”
The patient had developed a vesicovaginal fistula (VVF). A VVF is a hole located between the bladder and vaginal wall allowing a continuous involuntary discharge of urine. VVFs can cause emotional trauma and severe inconvenience. Nearly 1 percent of all women diagnosed with gynecological cancer develop these devastating conditions, and complex VVFs are by nature some of the most difficult cases that urologists and gynecologists encounter.
Due to the internal damage done by radiation, there were only few treatment options to repair the one-centimeter hole and none proved very successful, said Dr. Price.
“The high failure rate of these kinds of repairs for patients like Mrs. Hardin is primarily caused by the destructive effects of radiation which results in poor wound healing,” said Dr. Price. “This surgical repair is known to be a complicated procedure with significant morbidity and a high rate of failure due to the effect of radiation.”
However, after much research and dedication to finding a solution, Dr. Price invented a procedure never before performed on this kind of condition. The veteran surgeon used a fragile, dehydrated amniotic human membrane as a graft to patch the hole and assist in wound healing. The graft was put into place utilizing the da Vinci robotic system at St. Luke’s Health Memorial on June 2. According to Dr. Price, to his knowledge, no one has ever attempted and succeeded at performing a VVF repair after radiation, and no one has used an amniotic membrane to repair a defect like this.
Dr. Price reports there were no operative or postoperative complications, and Hardin was discharged the first day after surgery. Three weeks later, an imaging procedure demonstrated total healing.
Open surgical approaches have been the preferred procedure to repair VVFs for more than 50 years; however, they can be associated with significant morbidity and can result in prolonged hospitalization. While the benefits of minimally invasive surgical techniques in decreasing morbidity and hospital length of stay are well recognized, there have been few attempts to utilize these techniques, Dr. Price said.
“The da Vinci surgical robot provided improved visualization and technical advantages which allowed the procedure to be performed successfully,” Dr. Price added. “Human amniotic membranes have been used for decades on a variety of difficult to heal wounds. The membranes act as a barrier and promote tissue growth.”
Ms. Hardin said because of Dr. Price’s dedication, she’s gotten her dignity back and hopes this will pave the way for others like herself.
“I’m still feeling great. I hope this works for everyone like it did for me,” Hardin said. “I want this to be a stepping stone for others to be able to have a life they can be proud of.”