A vesicovaginal fistula is a tract or hole between the female bladder and the vagina. It allows the involuntary passage of urine from the bladder through the vagina and to the outside. Having a vesicovaginal fistula is very embarrassing and causes some health problems that need fixing. A vesicovaginal fistula is the most common type of urinary tract fistula in women. It is a disease that only affects women. If you think that your condition has worsened as a result of medical negligence, contact our vesicovaginal fistula solicitors for advice at no cost.

The main cause of a vesicovaginal fistula is childbirth. If the child doesn't fit through the birth canal very well or the pelvis is too small, there can be a necrosis of vaginal tissue and the death of the tissue erodes into the bladder, causing a hole which becomes permanent. The vesicovaginal wall, which is a single wall that connects the bladder to the vagina is very thin and can easily form a deep enough hole to open into the bladder.

A violent rape can cause a vesicovaginal fistula. It is common in countries where rape is a part of war, such as in the Republic of Congo. Doctors there are very skilled in repairing these types of fistulas as they are common war wounds. In other cases, a hysterectomy or cone biopsy can cause damage to the vaginal wall and a vesicovaginal fistula can occur.

The symptoms of a vesicovaginal fistula include the constant dripping of urine from the vagina. It can be as little as a few drops or as much as a stream. The vulva and vagina become irritated by the constant wetness and there can be redness and pain in the vaginal or vulvar area.

It is usually an injury to vaginal wall that causes a vesicovaginal fistula. A tumor, hysterectomy, radiation or anything else that reduces the blood supply to the vagina can result in a hole in the vagina. The hole can happen anywhere but if it connects to the bladder wall, a vesicovaginal fistula occurs.

Doctors can diagnose a vesicovaginal fistula using a visual examination of the vagina. An irritated hole can be found in the anterior wall of the vagina. Sterile dye or sterile milk can be inserted into the bladder via a catheter so that the dye or milk is looked for in the vaginal vault. Radio-opaque dye can be used to show the passage of dye unto the bladder via a catheter and outside the bladder into the vaginal space. X-rays of the bladder are necessary to see the passage of the dye into the vagina.

The treatment of a vesicovaginal fistula can involve simply treating the irritation and not to take care of the vesicovaginal fistula at all. In other cases, it involves the cutting out of the fistula and repairing the area involved in the fistula. The fistula is often infected with bacteria so antibiotics are used to clear up the infection before the fistula is removed. It is the reason why the fistula can't just be sealed over as infection prohibits the actual closing of the fistula. The fistula can be repaired via an abdominal or vaginal approach and a new blood supply may need to be introduced in order to make sure the surgery to repair the vesicovaginal fistula actually takes.

Sometimes a vesicovaginal fistula is treated by giving the individual a urinary catheter. This takes the pressure off the fistula so that the fistula begins to heal on its own. It takes several months of catheter use in order to have significant healing of the vesicovaginal fistula. The catheter can also be used along with surgery in order to take the added pressure of a full bladder on the repaired fistula.

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Vesico Vaginal Fistula Overview

The earliest evidence of a vesico-vaginal fistula was discovered in 1923 in the examination of a mummified body dating back to 2050 BC. There was a large vesico-vaginal fistula found in the body. In 950 AD, the vesico-vaginal fistula was commented on as was its relationship between having children too early and having a long labour. Surgical repair of a VVF was first described in 1663. It described using swan quills to put together the edges of the fistula. In the 1800s, treating VVFs were considered more commonplace using silver or lead wire to close the defect. Many doctors also treated VVFs with silver nitrate, which had minimal usage except in small VVFs. Other doctors of the era used a suprapubic approach to closing vesico-vaginal fistulae. Preoperative catheters were used to make sure there is no damage to the ureters in repairing the fistula.

In developing countries, the most common cause of a VVF is obstructed labor (97 percent). Necrosis from pressure on the tissue by the baby’s head results in a defect created in the vaginal wall that extends into the bladder. The rate of vesico-vaginal fistulae in developing countries such as Nigeria is about 350 women per 100,000 deliveries done in a hospital. It has been estimated that the number of VVFs in Nigeria that have yet to be repaired are between 800,000 and 1,000,000. The prevalence is also high in some Central Asian countries, in the Middle East, in Latin America and in some parts of the former Soviet Union. Cultures where having babies at a young age are at higher risk of getting VVFs.

In developed countries, VVF still is the most common type of urogenital fistula. These happen because of gynaecological surgery. For example, following a total abdominal hysterectomy, the rate of VVF is about 0.5-2 percent. Other data indicate that the rate is about 5000 women in the US each year. Most VVFs occurred as a result of benign conditions of the pelvis. Obstetric trauma accounted for about ten percent of cases of VVF. Radiotherapy accounted for 5 percent of cases and cancer surgery accounted for 5 percent of cases. In general, the VVFs in developed countries are due to punctures by surgical instruments and are generally much smaller than the VVFs found in developing countries. Obstetric trauma is often that made by forceps deliveries, caesarean deliveries, ruptured uterus and hysterectomy. Urologic surgery can also contribute to getting a VVF.

So what does a vesico-vaginal fistula act like? The greatest symptom is the uncontrolled leakage of urine from the vagina. There can also be an increase in vaginal discharge due to irritation of the vaginal wall with urine. The drainage of urine can be continuous in a large VVF or can be intermittent and made worse as the pressure in the bladder fills.

The injury may show up fairly quickly. In fact, about 90 percent of these fistulae show up within 7-30 days after the surgical insult. Obstetrical fistulae with damage to the anterior vaginal wall show up within 24 hours of delivery about 75 percent of the time. If the fistula is due to radiation, however, it can take as long as thirty years to develop a vesico-vaginal fistula from the time of initial injury. It is all quite variable. If the VVF was due to radiation, there can also be symptoms of radiation cystitis, bladder contraction and haematuria.

A vesico-vaginal fistula can be identified on visual inspection of the vagina. It can also be done using a cystoscope, where the doctor looks into the bladder with a camera. The doctor can instill dye into the bladder and look for the dye to come out of the vagina. This is a relatively sure sign of a vesico-vaginal fistula.

The VVF is best treated by surgically closing the inflamed fistula. Antibiotics can be used to sterilize the area before the surgery is done. If there is tissue death in the area of the fistula due to lack of blood supply, the doctor can restore that blood supply from another source. A catheter is needed to be worn in the bladder for many weeks or months until the fistula fully heals.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here