What is a Vesicovaginal Fistula?

A vesicovaginal fistula (VVF) is an abnormal connection between the bladder and the vagina, leading to continuous urinary leakage. This condition results in severe urinary incontinence, as urine bypasses the normal urinary tract and flows directly into the vagina. VVF can cause significant physical discomfort, emotional distress, and social embarrassment if left untreated.

Causes of Vesicovaginal Fistula

It most commonly develops due to:

• Surgical complications – Most often following gynaecological procedures like hysterectomy, bladder surgery, or pelvic radiation.
• Prolonged obstructed labour – A major cause in regions with limited obstetric care, leading to tissue damage and necrosis.
• Pelvic trauma – Injury from accidents, sexual violence, or fractures affecting the pelvic region.
• Severe infections – Chronic pelvic infections or tuberculosis affecting the bladder and vaginal walls.

Symptoms of Vesicovaginal Fistula

• Continuous leakage of urine from the vagina, causing persistent wetness.
• Recurrent urinary tract infections (UTIs).
• Foul-smelling vaginal discharge.
• Skin irritation and discomfort due to prolonged exposure to urine.
• Emotional distress and social withdrawal due to incontinence.

Diagnosis of Vesicovaginal Fistula

A thorough medical assessment is required for diagnosis, including:

• Pelvic examination – To check for urine leakage through the vagina.
• Dye test – Introducing a coloured fluid into the bladder to identify abnormal urine flow.
• Cystoscopy – A small camera inserted into the bladder to locate the fistula.
• Imaging studies (CT Urogram/MRI) – To assess the size and location of the fistula.

Treatment of Vesicovaginal Fistula and Urinary Incontinence

Treatment is essential to restore urinary control and improve the patient’s quality of life.

• Catheter drainage – Small fistulas may heal with continuous bladder drainage via a catheter.
• Surgical repair – The most effective treatment, involving closure of the fistula to restore normal bladder function. This can be performed through:
  • Transvaginal repair – A minimally invasive approach through the vagina.
  • Transabdominal repair – A more extensive procedure performed via the abdomen, often using tissue grafts.
• Post-surgical bladder training – To restore normal urinary function and prevent recurrent incontinence.