Vesicovaginal Fistula
What Is a Vesicovaginal Fistula?
A vaginal fistula is an abnormal opening that connects your vagina to another organ. When this abnormal opening is between the bladder and the vagina, it is called a vesicovaginal fistula. This opening causes constant urinary incontinence, resulting in a constant leakage of urine from your vagina.
What Are the Symptoms of a Vesicovaginal Fistula (VVF)?
The primary symptoms of VVF are persistent vaginal discharge and pain during vaginal intercourse. However, if the fistula is small, watery discharge after urination may be the only symptom.
Other symptoms of VVF:
Abdominal pain
Diarrhea
Fever
Nausea and vomiting
Unexplained weight loss
What Causes a Vesicovaginal Fistula (VVF)?
VVF can be congenital, meaning you may have been born with it. However, it is more commonly acquired, meaning it results from another medical condition or injury.
Congenital VVF is a rare condition. Worldwide, the most common cause of VVF is injury to the bladder during gynecological or other pelvic surgery. It can also develop due to gynecological cancer or as a result of radiation therapy.
In many low- and middle-income countries, the most common cause of VVF is prolonged or obstructed labor. Labor is considered obstructed when the fetus cannot enter the birth canal, even if uterine contractions are strong. In this situation, parts of the fetus—such as the head or shoulders—press against the pelvis and may cause injury to the surrounding tissues.
In addition to these, some other causes include:
Trauma during childbirth (such as assisted vaginal deliveries involving the use of instruments)
Infections and inflammatory diseases
Foreign objects (such as tampons)
Sexual trauma and violence
Vaginal laser procedures
How Is a Vesicovaginal Fistula (VVF) Diagnosed?
It is important to diagnose VVF correctly and to gather as much information as possible about it before surgery. There are several tests that can be performed for diagnosis:
Physical examination: The area where the fistula is located will be examined for inflammation or other abnormalities. This can help determine the best surgical approach for repair.
Imaging tests: Your doctor may order a pelvic X-ray or a CT scan to see how your bladder and uterus look and to determine the exact location of the fistula or opening.
Double-dye test: In this test, your bladder is filled with a blue-dyed solution, and then a tampon is inserted into your vagina. If the tampon turns blue, a VVF is present.
Cystourethroscopy: Cystoscopy can also help clarify exactly where the VVF is located. This can further assist in treatment planning.
What Is the Treatment for a Vesicovaginal Fistula (VVF)?
For small, noncancerous VVFs detected early, conservative treatments that allow the opening to close on its own may be effective. These treatments include:
Catheter:To help alleviate your symptoms, a catheter may be inserted for 2 to 8 weeks in combination with medications called anticholinergics, which help stop certain involuntary muscle movements.+
Electrocoagulation: This procedure uses heat generated by an electric current to remove the innermost layer of tissue—known as the mucosal layer—surrounding the VVF. A catheter will then be inserted and left in place for 2 to 4 weeks while you heal.
If conservative treatment fails or is not an appropriate option, surgical repair may be performed:
Laparoscopic: Laparoscopic surgery is an alternative to open surgery. Using a small camera and a tube, the procedure is performed through a small incision or opening.
Robotic: In robotic surgery, a robotic device assists the surgeon.
Transvaginal:During transvaginal surgery, the procedure is performed through the vagina.
Open transabdominal: This procedure involves an open incision in the abdominal area.
During fistula repair surgery, the opening through which urine leaks into your vagina is closed to stop urinary incontinence. If there is any damage to your bladder, additional procedures may be necessary.