I’ve been through the Cave of Retzius with Dr Ambaye – amazing fistula surgeon

I spent another couple of amazing days with the fistula surgeon from Addis. Her name is Dr Ambaye (you will read about her in “Hospital by the River”). She now works in and around Addis travelling to the hospitals when they have enough cases for her to operate on. On Monday and Tuesday there were much more complicated cases.

**WARNING – MEDICAL INFO THAT SOME PEOPLE MIGHT NOT LIKE!!!!

Circumferential defects

This is where the uretha and the bladder have been completely broken down – so there is the bladder up above and then no connection whatsoever to the urethra below. I was thinking “How on earth is this ever going to work!?” She mobilised bottom part of the bladder which then allowed the bladder to meet the urethra. She joined the anterior part of the bladder to the urethra to close the gap and then closed the rest of the bladder posteriorly as the defect in the bladder was bigger than the proximal end of the urethra that it was required to join to.

Bladder to anterior abdominal wall

This patient had been operated on 4-5 times previously but without success. She had a circumferential defect (as above) but also she had urine leaking from her anterior abdominal wall. What Dr Ambaye did this time was to enter the cave of Retzius and continue all the way up until she reached the very top of the bladder and found the communication to the anterior abdominal wall and then calmly cut the entire length of the anterior wall of the bladder until she reached the fistula, she then cut the scar tissue out and repaired the bladder. A truly amazing operation. She later told me that she likes the challenge of a difficult case and finds the successes extremely gratifying.

I had dinner with Dr Ambaye that night and she spoke about how she feels when she can make such a difference to the lives of these women. She learnt fistula surgery from Catherine and Reg Hamlin but she said the main thing that she learnt was how much they cared for the patients and she also inherited this intense passion for caring for the fistula patients.