Vesicovaginal Fistula

Fistulas are defined as the formation of abnormal connecting channels between a patient's internal organs.  A vesicovaginal fistula is a condition in which an unwanted channel forms between the bladder (urinary bladder) and the vagina and urine leaks into the vagina. Because of this condition urine sometimes leaks slightly out of the vagina. As well as being a serious medical problem, this condition can adversely affect quality of life because of the leakage and unpleasant odour.

Formation of a Vesicovaginal Fistula

Vesicovaginal fistula is frequently seen in women who have undergone gynaecological operations such as caesarean section or removal of the uterus (hysterectomy), who have had an abscess-forming infection between the bladder and the vagina, or who have received radiation treatment (radiotherapy) because of cancer of the uterus or cervix.

Vesicovaginal fistulas are generally a complication arising after surgery performed to treat problems in the bladder or vagina. They may also be linked to disease or gynaecological cancer. Sometimes they can be a side effect of radiation therapy or surgery used for cancer treatment. Severe or recurrent urinary tract infections in particular can sometimes cause fistulas, but this is a rare occurrence.

Symptoms of a Vesicovaginal Fistula

The most frequent symptom of a vesicovaginal fistula is continuous urinary incontinence day and night. Patients have a continuous leakage of urine from the bladder into the vagina.

Diagnosis of a Vesicovaginal Fistula

In patients with suspected vesicovaginal fistula, a substance called methylene blue is introduced into the urinary tract and it is checked whether it comes out of the vagina. A definitive diagnosis is made by showing the opening of the fistula inside the bladder with cystoscopy (a thin instrument with a camera at its tip).

The doctor generally performs a close physical examination of the area to obtain further information. Depending on what is found, imaging tests are performed that can indicate what is happening in the woman's body. The most common tests will be an X-ray of the pelvis or a CT scan that uses a dye (also called contrast) to highlight the tissues in this part of the body and makes it easier to identify the source of the problem. The dye is injected into the woman's body through a vein or through a catheter placed in the bladder.

Treatment of a Vesicovaginal Fistula

In small fistulas, the fistula can be treated by placing a catheter in the bladder for 2-3 weeks. In larger fistulas surgical treatment may be required.

Through an incision made from the vagina or the lower abdomen, the tissue around the fistula channel is completely removed until tissue with good blood supply is reached.