VESICOVAGINAL FISTULA

INTRTODUCTION

Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending

between the bladder (vesica) and the vagina that allows the continuous
involuntary discharge of urine into the vaginal vault.
In addition to the medical sequela from these fistulas, they often have a
profound effect on the patient's emotional well-being.
CAUSES

It may be the result of a congenital birth condition such as VATER or

VACTERAL. It is often caused by childbirth (in which case it is known as
an obstetric fistula), when a prolonged labor presses the unborn child
tightly against the pelvis, cutting off blood flow to the vesicovaginal wall.
The affected tissue may necrotize (die), leaving a hole.
Vaginal fistulas can also result from particularly violent cases of rape,
especially those involving multiple rapists and/or foreign objects. Some
health centers in countries such as the Democratic Republic of Congo
have begun to specialize in the surgical repair of vaginal fistulas.
It can also be associated with hysterectomy, cancer operations, radiation
therapy and cone biopsy.
TREATMENT

Vesicovaginal fistulae are typically repaired either transvaginally or

laparoscopically, although patients who have had multiple transvaginal
procedures sometimes attempt a final repair through a large abdominal
incision, or laparotomy.
The laparoscopic (minimally invasive) approach to VVF repair has
become more prevalent due to its greater visualization, higher success
rate, and lower rate of complications.
Possible complications of surgical treatment

 Recurrent formation of the fistula

 Injury to ureter, bowel, or intestines
 Vaginal shortening