Vesicovaginal Fistula

Vesicovaginal fistula is an abnormal opening that connects the vagina to another organ.

The most common type of vesicovaginal fistula is the connection of the vagina to the bladder. This condition often causes a continuous involuntary release of urine into the vaginal vault.

Injury to the bladder during urologic, gynecologic, or pelvic operations are the most common causes.
It could occur during a hysterectomy, radiation therapy, or develop through a severe infection.

Additional Risk Factors

Childbirth complications may contribute to fistula formation

Pressure during prolonged labor can damage tissues

Reduced circulation may lead to tissue breakdown

Vesicovaginal fistula can result from prolonged labor during childbirth. If the unborn child is pressed tightly against the pelvis, loss of circulation in the vesicovaginal wall may present complications. Loss of blood flow for an extended amount of time may cause the distressed tissue to die, creating a hole.

Symptoms and Diagnosis

You should contact your doctor if you are experiencing any of the following symptoms:

Repeated vaginal or urinary tract infections

Hygienic problems

Swollen or infected tissue

Diagnostic Evaluation

To diagnose vesicovaginal fistula, a urologist will likely use cystoscopy (bladder scope) to assess the abnormal tract.

A voiding cystourethrogram may be performed

A CAT scan may be used to view the affected area

Imaging helps rule out ureter injuries or additional fistulas

Treatment Options

Doctors review medical history first

Tests determine treatment candidacy

Catheter drainage may be attempted

Surgery is usually required

Once vesicovaginal fistula has been formally diagnosed by the urologist, treatment options will be explored. Possible treatment options will be explained when the doctor evaluates the candidate’s health history. The following tests may be performed to establish candidacy: urine test, pelvic exam, routine blood tests, and cystourethroscopy. This evaluation will allow the doctor to provide the most viable treatment plan. Depending on the severity of the vesicovaginal fistula, treatment options vary. In rare cases, treatment may involve inserting a catheter drainage to provide relief. Close observation by the medical team is required during this trial period. In most cases, surgical repair is needed to reconstruct the fistula. This method is also the most effective.

Surgical Procedure and Recovery

Surgical Repair

In a surgical facility, anesthesia will be administered to make the procedure more comfortable. Surgical repair of the vesicovaginal fistula can be done vaginally or abdominally. The vaginal approach is less invasive and is often the preferred method. Laparoscopy may be used to make the surgical process more comfortable. Scar tissue is removed so healthy tissue can be interposed.

Surgical Process

The vaginal and bladder openings are closed during the procedure. The bladder is then filled with sterile water to search for any leaks, and repairs are made as necessary. The surgical procedure normally takes between 2–6 hours to complete.

Recovery

A full recovery without complications is very likely with proper recovery. Any tissue that was removed during the procedure may be sent for a biopsy to eliminate the possibility of cancer. If urine leakage, nausea, or other uncomfortable symptoms occur after surgery, patients should contact their healthcare provider immediately.