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

Vaginal fistulas can arise from various causes, including:

Surgical complications: Procedures involving the vaginal wall, anus, or perineum, such as hysterectomies, may lead to fistulas, especially in cases of prolonged surgery, significant blood loss, or infections. The risk is higher in people with diabetes or who use tobacco.
Childbirth injuries: Prolonged labour, vaginal tearing, or infections from surgical cuts during delivery can cause fistulas, more commonly in developing countries.
Inflammatory conditions: Diseases like Crohn's disease and, less frequently, ulcerative colitis may result in fistulas, though proper treatment reduces this risk.
Cancer and radiation: Pelvic cancers (e.g., of the cervix or rectum) and radiation therapy can lead to tissue damage, causing fistulas.
Diverticulitis and faecal impaction: These digestive conditions, especially in older adults, can contribute to fistula formation.

Vesicovaginal Fistula Symptoms

Symptoms of a vaginal fistula may include:

Leakage of urine, stool, or gas through the vagina.
Frequent urinary tract infections.
Urine with an unusual odor or blood.
Abnormal vaginal discharge with an unusual appearance or smell.
Pain during sexual intercourse.
Pain, swelling, or irritation in the perineal area (between the vagina and anus).
Recurrent vaginal infections.

The specific symptoms experienced depend on the fistula's location.

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.

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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.

Vesicovaginal Fistula Diagnosis

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. to take control of your health journey?

Vesicovaginal Fistula Treatment

Conservative Management

In some cases, small vesicovaginal fistulas may heal spontaneously with conservative management. This approach typically includes vesicovaginal fistula repair if needed to address persistent issues.

Bladder catheterisation to divert urine flow away from the fistula
Antibiotic therapy to prevent or treat infections
Nutritional support to promote tissue healing

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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.

Complications of Vesicovaginal Fistula

Vaginal fistulas can result in various health issues, including:

Recurrence of the fistula.
Chronic pelvic infections.
Stenosis, or narrowing of the vagina, anus, or rectum.
Difficulty conceiving.
Stillbirth or pregnancy loss after 20 weeks.

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Frequently Asked Questions

What causes vesicovaginal fistula?

Vesicovaginal fistula is primarily caused by prolonged or obstructed labor during childbirth, which leads to tissue damage between the bladder and vagina. Other causes include surgical complications, pelvic cancer, or trauma from pelvic injuries.

What are the symptoms of vesicovaginal fistula?

The main symptom of vesicovaginal fistula is continuous urinary leakage through the vagina. It can also cause irritation, infections, and an unpleasant odor due to urine being retained in the vaginal area.

How is vesicovaginal fistula treated?

Vesicovaginal fistula is generally treated with surgical repair, often involving closure of the fistula and restoration of normal bladder and vaginal function. In some cases, a catheter may be used temporarily to manage the condition before surgery.

What are the types of fistulas in females?

Females can experience different types of fistulas, including vesicovaginal, rectovaginal, and urethrovaginal fistulas. These conditions involve abnormal connections between organs like the bladder, vagina, or rectum.

How is vesicovaginal fistula diagnosed with radiology?

Radiological diagnosis of vesicovaginal fistula often involves techniques like cystography or contrast-enhanced imaging, which helps identify the fistula tract between the bladder and vagina. A CT scan or MRI may also be used for more detailed visualization.