Vesicovaginal Fistula

The term fistula may be used to describe a variety of issues pertaining to an irregular passage within the body. Typically, a fistula refers to the creation, or opening, between two or more organs. A vesicovaginal fistula (VVF) describes the creation of a passageway between the vagina and bladder. While this medical condition may seem rare, it’s commonly associated with complications from childbirth.

• VVF occurs when the mother’s pelvic region is too narrow to accommodate the baby’s head.
• This scenario results in a prolonged childbirth, which can result in the creation of a fistula.

The formation of vesicovaginal fistula is related to trauma within the pelvic region. Prolonged or obstructed labor is a common cause of VVF. However, a fistula between the vagina and bladder may occur outside of the realm of childbirth.

Some of the more common causes of vesicovaginal fistula is trauma to the bladder during a medical procedure, such as:

• Pelvic surgery
• Urologic examination/surgery
• Gynecologic examination/surgery
• Episiotomy during labor

Although childbirth is a risk factor for vesicovaginal fistula, this cause is more common within developing countries rather than in industrialized nations, such as the United States. Other potential risk factors of developing VVF include certain types of cancer, such as cervical and pelvic, as well as serious infections and traumatic injury.

The most common symptoms of vesicovaginal fistulas include:

• Foul scent from vagina
• Persistent urinary tract or vaginal infections
• Urine leaking from the vaginal opening
• Abscess around the vagina
• Severe inflammation in the vaginal area

Outside of social embarrassment, complications from a vesicovaginal fistula relates to prolonged infections or reoccurring fistulas. The risk of serious complications is higher for women diagnosed with Crohn’s disease, which increases the risk of repeat fistulas or improper fistula healing.

Full diagnosis requires a complete pelvic examination. To confirm VVF, a cystoscopy is typically performed to identify and map the fistulous passageway. Other methods of diagnosis include a CAT scan and voiding cystourethrogram, which offers visual confirmation of the fistula and review of connected organ health, such as ureter tubes.

After a positive diagnosis, treatment methodology depends on VVF severity. Minor cases are often treated by inserting a catheter to drain urine from the bladder and waiting to see if the fistula heals on its own. Another option may be to seal the passageway with a plug or glue manufactured out of natural proteins.

However, surgical intervention is often required to completely close the fistula. The type of surgery depends on the location and severity of the fistula. For example, a laparoscopic procedure may be performed, which is minimally invasive. However, if the VVF is accompanied by additional fistulas, abdominal surgery may be necessary.