The term “fistula” refers to an abnormal passage within the body, typically between two or more organs. A vesicovaginal fistula (VVF) specifically describes a passageway between the vagina and bladder, often resulting from childbirth complications. VVF occurs when a narrow pelvic region during childbirth leads to prolonged labor, causing the formation of a fistula.
Causes of Vesicovaginal Fistula
A vesicovaginal fistula can be caused by:
- Injuries
- Inflammation
- Infection
- Gynecological cancer
- Radiation therapy or surgery for cancer treatmen
- Recurrent urinary tract infections (UTIs)
VVF is primarily caused by trauma in the pelvic region. Prolonged or obstructed labor is a common cause, but VVF can also result from bladder trauma during medical procedures such as pelvic surgery, urologic or gynecologic examinations/surgeries, and episiotomy during labor:
While childbirth is a significant risk factor for VVF, it is more prevalent in developing countries than in industrialized nations like the United States. Other risk factors include certain cancers (cervical and pelvic), serious infections, and traumatic injuries.
Symptoms and Complications
Common symptoms of vesicovaginal fistulas include:
- Foul vaginal odor
- Persistent urinary tract or vaginal infections
- Urine leakage from the vaginal opening
- Vaginal abscess
- Severe vaginal inflammation
Beyond social discomfort, complications from VVF involve prolonged infections and recurring fistulas. Women with Crohn’s disease face a higher risk of serious complications due to increased chances of repeat fistulas or improper healing.
Diagnosis and Treatment
Most vesicovaginal fistulas develop post-surgery and lead to urinary leakage. The initial step in diagnosing this condition involves performing a physical examination and ordering imaging tests like a pelvic X-ray or a computed tomography (CT) scan to visualize the tissues and pinpoint the issue. Additionally, a cystoscopy may be conducted to assess the bladder.
The patient’s physician may perform a cystoscopy to identify and map the fistulous passageway. Other diagnostic methods include a CAT scan and voiding cystourethrogram, which provide visual confirmation of the fistula and assess the health of connected organs like the ureter tubes.
Treatment depends on the severity of the VVF. Minor cases may be treated by inserting a catheter to drain urine and allow the fistula to heal naturally. Another option is sealing the passageway with a plug or glue made from natural proteins.
However, surgical intervention is often necessary to close the fistula completely. The type of surgery depends on the fistula’s location and severity. Minimally invasive laparoscopic procedures may be used, but more severe cases with additional fistulas might require abdominal surgery.
Choose UCI Pelvic Health Center
If you are experiencing symptoms of a vesicovaginal fistula, such as urinary leakage, recurring infections, or pelvic discomfort, the UCI Pelvic Health Center is here to help. Our team of specialists offers comprehensive diagnostic services, including physical exams, imaging tests, and cystoscopy, to accurately identify and assess the condition. We provide personalized treatment plans, ranging from conservative management to advanced surgical interventions, tailored to your specific needs.