Atrium Health Navicent Women's Care Urogynecology & Pelvic Surgery

Vsicovaginal Fistula
Prevention, Diagnosis and Repair of Vesicovaginal Fistula

Elderly woman sitting in a wheel chair

What is a Vesicovaginal Fistula (VVF)?

VVF is the destruction of the bladder neck, causing an opening between the vagina and the urinary tract. This is due to several possible causes, with the greatest number of cases occurring during childbirth. In prolonged labor, the urethra and surrounding tissues are destroyed, leading to urine leaking from the vagina. Other causes of vesicovaginal fistula are endometriosis, uterine fibroids and damage during surgery, mainly hysterectomy.

Obstetric fistulas are more common in undeveloped countries, partly because of the lack of medical expertise available to prevent and treat the condition. Another factor is the greater number of child pregnancies in those countries. The maternal pelvic area is not developed enough for the infant's head to pass through the birth canal, leading to prolonged and extreme pressure on the bladder neck, enough to destroy tissue.

How is this Condition Repaired?

Rarely, the VVF repair procedure is catheterizing the bladder for several weeks until the opening spontaneously closes. If the urogenital fistula is small, immediate repair is not complex and is suggested for the patient's health and quality of life. Often, surgery must be postponed because of swelling and bleeding due to childbirth.

The first attempt at surgical repair of a vesicovaginal fistula has the highest rate of success. Because of this, it is vital that the patient is free of infection and well rested and that a surgeon performs the surgery experienced in vesicovaginal fistula repair. If surgery has to be postponed, a urinary catheter may be used in the meantime to encourage the tissue to heal spontaneously.

Depending on the location of the fistula, minimally invasive VVF surgery can be performed through the vagina. Another alternative to major surgery is laparoscopy, a procedure that uses a smaller incision and is less traumatic to the body. During VVF surgery, a catheter is inserted for bladder drainage and left in place as the patient heals.

What are Possible Complications of VVF Surgery?

Complications can include reduced bladder capacity, recurrence of VVF and a chronically irritated lower urinary tract. Patients are given medicine to prevent bladder spasms after surgery to encourage healing and prevent discomfort. Success is achieved in vesicovaginal fistula surgery at the first attempt in over 85 percent of cases.

If VVF is not treated, it can lead to urinary tract infections, vaginal infections, and infertility. There is also an unpleasant odor attached to the continually leaking urine, a factor that leads to the shunning of the affected women in some parts of the world. A speedy diagnosis followed by expert surgical repair has far less risk involved than leaving the condition untreated.

How Can Vesicovaginal Fistulas Be Prevented?

  1. Preventing VVF as a complication of hysterectomy:
  • Take the time to make sure the entire operative area is visible.
  • Minimize bleeding and ensure adequate sutures in the vaginal wall.
  • Separate the bladder from the vagina 1-2 cm during surgery to avoid accidentally suturing the bladder.
  • Fill and empty the bladder during the operation to check for bladder lacerations.
  • Preventing VVF during childbirth:
    • Decreasing the incidence of child pregnancy is a major way of preventing maternal vesicovaginal fistulas.
    • Access to better health care, including caesarean surgery when indicated, can prevent extended labor, a second major factor in VVF.
    • Education of the population in underdeveloped countries as to the cause and prevention of obstetric vesicovaginal fistula may lead to a greater willingness to seek medical attention during pregnancy and delivery.
    • Information and community awareness about maternal vesicovaginal symptoms can help remove the stigma toward those who suffer from the condition and encourage prevention.
    • Reduction of poverty, especially in rural areas, will enable more women to afford medical care during pregnancy.
    • Access to family planning services will enable girls and women to delay childbirth until their bodies have matured enough to handle it.