Vesicovaginal fistula

A medical condition involving an abnormal fistulous tract between the bladder and the vagina

Overview

A vesicovaginal fistula is an abnormal fistulous tract that forms between the urinary bladder and the vagina. This condition results in the continuous involuntary discharge of urine into the vaginal vault. It is a significant medical condition that can lead to severe physical and psychological distress for affected individuals.

Causes

The most common cause of vesicovaginal fistula is prolonged obstructed labor, which can lead to tissue necrosis due to pressure from the fetal head. Other causes include surgical trauma, particularly from hysterectomy, pelvic radiation therapy, and pelvic inflammatory disease.

Symptoms

The primary symptom of a vesicovaginal fistula is continuous urinary incontinence, where urine leaks uncontrollably from the vagina. Patients may also experience vaginal discharge, urinary tract infections, and irritation of the vaginal and surrounding skin.

Diagnosis

Diagnosis of a vesicovaginal fistula typically involves a combination of patient history, physical examination, and imaging studies. A dye test, where a colored dye is introduced into the bladder, can help confirm the presence of a fistula if the dye appears in the vagina. Cystoscopy and urography are also useful diagnostic tools.

Treatment

Treatment of vesicovaginal fistula often requires surgical intervention. The surgical approach depends on the size, location, and cause of the fistula. Options include transvaginal or transabdominal repair. In some cases, conservative management with catheterization may be attempted initially.

Prognosis

With appropriate surgical treatment, the prognosis for vesicovaginal fistula is generally good, with high rates of successful closure and resolution of symptoms. However, the condition can recur, and some patients may experience persistent urinary incontinence or other complications.

Prevention

Preventive measures include improving access to quality obstetric care, timely intervention during labor, and careful surgical techniques during pelvic surgeries. Education and training of healthcare providers in the management of labor and surgical procedures can also reduce the incidence of vesicovaginal fistulas.

Related pages

• Fistula
• Urinary incontinence
• Obstetric fistula
• Pelvic surgery

Diagram illustrating a vesicovaginal fistula