Vesicovaginal Fistula: Causes, Symptoms and Diagnosis

A vesicovaginal fistula (VVF) is a distressing medical condition that forms an abnormal connection between the bladder and the vagina. This condition can lead to continuous, unintentional urine leakage from the bladder into the vaginal vault. Vesicovaginal fistulas can be physically and emotionally debilitating, severely impacting the quality of life of those affected. Understanding the causes, symptoms, types, and treatments of vesicovaginal fistula is essential for effective diagnosis and management.

---

What is a Vesicovaginal Fistula?

A vesicovaginal fistula is a type of fistula—an abnormal passageway that develops between two organs or vessels that do not usually connect. In the case of VVF, this passage forms between the bladder and the vagina, leading to an involuntary discharge of urine into the vaginal canal.

---

Causes of Vesicovaginal Fistula

Surgical Causes

One of the most common causes of vesicovaginal fistulas is surgical intervention. Gynecological surgeries, particularly hysterectomies, account for a significant number of VVF cases. During such procedures, inadvertent damage to the bladder can occur, creating a fistula.

Obstetric Causes

Complications during childbirth can also lead to the development of a vesicovaginal fistula. Prolonged labor, especially in regions with limited access to emergency obstetric care, can result in sustained pressure on the bladder and vaginal tissues, leading to tissue necrosis and subsequent fistula formation.

Radiation Therapy

Radiation therapy for pelvic malignancies is another potential cause. Radiation can cause tissue scarring and weaken the bladder and vaginal walls, increasing the risk of fistula formation.

Infection and Inflammation

Chronic infections and inflammatory conditions, such as pelvic inflammatory disease (PID), can also contribute to the development of a vesicovaginal fistula. These conditions can lead to tissue damage and create passageways between the bladder and vagina.

Trauma

Traumatic injuries to the pelvic region, whether from accidents or sexual violence, can also result in VVF. Such injuries can directly damage the bladder and vaginal walls, leading to fistula formation.

---

Symptoms of Vesicovaginal Fistula

The hallmark symptom of a vesicovaginal fistula is continuous urine leakage from the vagina. This symptom can be accompanied by:

---

Types of Fistulas in Females

Vesicovaginal Fistula

As previously discussed, this type of fistula forms between the bladder and the vagina, resulting in continuous urine leakage.

Rectovaginal Fistula

This type of fistula forms between the rectum and the vagina, leading to the passage of fecal matter into the vaginal canal. Like VVF, rectovaginal fistulas can cause significant discomfort and social stigma.

Ureterovaginal Fistula

A ureterovaginal fistula occurs when an abnormal passage forms between a ureter (the tube that carries urine from the kidneys to the bladder) and the vagina. This condition also results in continuous urine leakage, but it originates from the kidneys rather than the bladder.

---

Diagnosis of Vesicovaginal Fistula

Clinical Examination

The first step in diagnosing VVF is a thorough clinical examination by a healthcare professional. This typically includes a detailed medical history and a pelvic examination to identify any abnormal openings or discharge.

Radiological Imaging

Radiological imaging plays a crucial role in diagnosing vesicovaginal fistulas. Techniques such as cystography, intravenous pyelography (IVP), and magnetic resonance imaging (MRI) can provide detailed images of the bladder and surrounding structures, helping to identify the fistula's location and extent.

Dye Testing

Dye tests involve injecting a colored dye into the bladder and observing its passage. If the dye appears in the vaginal canal, it confirms the presence of a vesicovaginal fistula.

Cystoscopy

Cystoscopy is a procedure that allows direct visualization of the bladder and urethra using a specialized instrument called a cystoscope. This technique can help identify the fistula's exact location and guide treatment planning.

Treatment of Vesicovaginal Fistula

Conservative Management

In some cases, small vesicovaginal fistulas may heal spontaneously with conservative management. This approach typically includes:

Surgical Repair

Surgical intervention is often necessary for larger or persistent fistulas. Several surgical techniques can be employed, including:

Transvaginal Repair

This approach involves accessing the fistula through the vaginal canal. The surgeon repairs the fistula by closing the abnormal passage with sutures or grafts.

Transabdominal Repair

In cases where the fistula is not accessible through the vaginal canal, a transabdominal approach may be used. The surgeon accesses the fistula through an abdominal incision and repairs it using sutures or grafts.

Laparoscopic and Robotic-Assisted Repair

Minimally invasive techniques, such as laparoscopy and robotic-assisted surgery, can also be used to repair vesicovaginal fistulas. These approaches offer the advantage of smaller incisions, reduced postoperative pain, and faster recovery times.

Postoperative Care

Postoperative care is crucial for successful fistula repair. Patients may require: