Overview

Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. The entity is one among the most distressing complications of gynecologic and obstetric procedures. VVFs can be classified in various ways. Simple fistulas are usually small in size (≤0.5cm) and are present as single non-radiated fistulas. Complex fistulas include previously failed fistula repairs or large-sized (≥2.5 cm) fistulas, more often a result of chronic diseases or radiotherapy. Although the incidence of VVFs has become rare in the industrialized world, they still commonly occur in developing countries. The good news is that VVFs are treatable, often with surgery or often through a minimally invasive route, offering significant relief from symptoms like constant leakage. 

Symptoms

Vesicovaginal fistula symptoms can include:

• Leaking pee from your vagina (urinary incontinence)
• Thin and/or foul-smelling vaginal discharge
• Painful intercourse
• Irritation in your vagina or vulva
• Constant wetness in your underwear, even when you just went to the bathroom
• Leaking that starts one to two weeks after pelvic surgery

Your symptoms may vary based on how large the opening is and other factors. Tell a healthcare provider as soon as possible if you have these symptoms.

Causes

In general, a vesicovaginal fistula forms when there’s damage to tissue between your vagina and bladder that results in the death of that tissue. This forms a hole, or a fistula.

pelvic surgery that results in accidental tissue damage. Examples include bladder surgery and hysterectomy.

In many parts of the world with fewer resources, a long, difficult labor (obstructed childbirth) is the most common cause.

Less commonly, bladder cancer or cervical cancer, or treatment like radiation, can lead to a VVF.

Diagnosis and Tests

To start, a healthcare provider will ask about your symptoms and medical history. They’ll likely do a physical exam and pelvic exam. Your provider will also check that the leak isn’t coming from a ureter (the tube from your kidney to your bladder). Ureter leaks need a different plan.

Your provider will then recommend specific tests to diagnose a vesicovaginal fistula. These tests can also help your provider plan for surgery. Tests may include:

• Dye test: Your provider may fill your bladder with blue fluid. They might also give you medicine that turns your pee orange. You’ll insert a tampon into your vagina. A tampon that turns blue suggests a bladder-to-vagina fistula. Orange without blue suggests a ureter-to-vagina fistula.
• Cystoscopy: A urologist uses a lighted device to look inside your bladder.
• CT urogram: This imaging test uses a contrast dye to take detailed images of your bladder and the rest of your urinary system.
• Other tests: Sometimes, a pelvic MRI or a speculum exam under anesthesia helps map the fistula

Management and Treatment

A few small, very new fistulas may close with continuous bladder drainage (a Foley catheter) for several weeks. But most need surgery. The main treatment for a vesicovaginal fistula is surgery to close the opening.

Your surgeon may operate through your vagina or abdomen (sometimes, with laparoscopy or a robot). Together, you’ll decide on the type of surgery that’s best for you.

After surgery, you’ll need a Foley catheter for two to three weeks to drain your pee. Your healthcare provider will want to make sure the fistula has healed before removing the catheter.

Recovery time

It can take six to eight weeks to recover from vesicovaginal fistula surgery. Your healthcare provider will give you specific instructions for recovery. In general, they may recommend you avoid the following for six to eight weeks:

• Sexual intercourse
• Strenuous activity
• Heavy lifting

Avoiding these activities gives the fistula time to heal.

Takeaway

Maybe you’ve never heard of a fistula before. But ever since you got a vesicovaginal fistula diagnosis (VVF), it’s all you can think about. VVFs can disrupt your daily routine and even your sense of self. Thankfully, treatment can help you regain control over the parts of your body that seem to have a mind of their own. Still, recovery may take time. Lean on your healthcare provider for guidance and support.

If you have a condition that’s affecting your urinary system, you want expert advice. At Global Treatment services we ll work to create a treatment plan that is right for you, kindly contact us via email query@gtsmeditour.com or whatsapp on +91 9164822440 for the best available service /treatment option .