Vesicovaginal fistula

Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF), which is an abnormal fistulous tract extending between the bladder (vesica) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

Etiology

Vesicovaginal fistula is often caused by obstetric trauma, specifically prolonged obstructed labor, but can also be a result of radiation therapy, malignancy, and surgical complications, particularly from procedures such as hysterectomy.

Pathophysiology

In the case of obstetric fistulas, prolonged obstructed labor causes tissue necrosis due to compression of the soft tissues between the fetal head and the maternal pelvic bone, leading to the formation of a fistula. In the case of iatrogenic fistulas, the fistula is often a result of accidental injury to the bladder or ureters during pelvic surgery.

Clinical Presentation

Patients with vesicovaginal fistula often present with continuous urinary incontinence, which can lead to social isolation and psychological distress. Other symptoms may include recurrent urinary tract infections, vaginal irritation, and foul-smelling vaginal discharge.

Diagnosis

Diagnosis of vesicovaginal fistula often involves a detailed history and physical examination, as well as imaging studies such as cystoscopy and intravenous urography. Other diagnostic procedures may include dye tests, where a colored dye is instilled into the bladder and its presence in the vagina is observed.

Treatment

Treatment of vesicovaginal fistula often involves surgical repair, either through a vaginal or abdominal approach. The choice of surgical approach often depends on the size and location of the fistula, as well as the surgeon's experience and preference. In some cases, conservative management may be attempted, particularly in cases where the fistula is small and the patient is asymptomatic.

Epidemiology

Vesicovaginal fistula is most common in developing countries, particularly in sub-Saharan Africa and South Asia, where access to emergency obstetric care is limited. However, it can also occur in developed countries, often as a result of surgical complications.

See Also

• Obstetric fistula
• Ureterovaginal fistula
• Rectovaginal fistula

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Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on Vesicovaginal fistula for any updates.

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