Vesicovaginal Fistula

A vesicovaginal fistula is an abnormal opening that develops between the bladder and the wall of the vagina. This results in the leakage of urine out of the vagina, sometimes lightly, but it can be steady if the fistula is large. This condition is a serious medical problem, and it is very upsetting. The leakage is embarrassing and can smell bad.

Causes of fistulas may be due to infections, injuries, and inflammation. They may occur in many parts of the body.

A vaginal fistula doesn't hurt but may cause discomfort and other problems that need medical care.

The most common symptom is

• Continuous dribbling of urine from the bladder into the vagina.
• The genital area may get infected or sore,
• You may have pain during intercourse.

Other symptoms of vaginal fistulas include:

• Fever
• Pain in the lower abdomen
• Diarrhea
• Nausea
• Vomiting

The reasons for vesicovaginal fistula are tissue damage that occurs due to trauma, medical procedures, or diseases such as

• Childbirth
• Abdominal surgery (cesarean section or hysterectomy)
• Pelvic or cervical cancer
• Radiation treatment
• Bowel disease like diverticulitis
• Infection (including, a tear you had during childbirth)
• Traumatic injury
• Sometimes repeat urinary tract infections can lead to fistulas, but it's rare.

Most vesicovaginal fistulas develop soon after surgery. Patients will face problems with urine leakage. The doctor will typically do a close physical exam of the area to understand the problem. Based on the finding’s tests are ordered. The most common tests include:

• Cystoscope exam - the doctor uses a thin device called a cystoscope, which is sent to see inside the bladder and urethra to locate the damage.
• Dye test - dye solution is filled in your bladder, and the patient is asked to cough or bear down. If you have a vaginal fistula, the dye will leak into your vagina.
• Retrograde pyelogram- in this test, the dye is injected through your bladder into your ureters. An X-ray can show if there is any leakage between the ureter and your vagina.
• Fistulogram- this is an X-ray image of the fistula; it can show whether you have one or many fistulas and if other pelvic organs may be involved.
• Pelvic MRI- in this, magnetic and radio waves take images of your rectum and vagina to help show the details of a rectovaginal fistula.
• CT urogram- a dye solution is injected into a vein, and a CT scan takes images of your vagina and urinary tract.

Surgery is the only way to fix vesicovaginal fistulas. Sometimes, additional procedures are required to correct the original cause of the problem, such as damage to the bladder.

Surgery done to correct vesicovaginal fistulas is generally very successful.

For women who have a fistula due to cancer may not have a good outcome.

The doctor will place a catheter in the bladder for few weeks while the surgical area heals.

Almost everyone who has a fistula needs surgery. What kind of surgery you get depends on the type of fistula and where is it located?

It could be laparoscopic surgery, in which the doctor makes small incisions and inserts cameras and tools. Or it could be abdominal surgery where you get a regular incision with a tool called a scalpel.