Vesicovaginal Fistula

A vesicovaginal fistula is an abnormal connection between the bladder and the vagina that allows urine to flow from the bladder into the vagina.
The most common cases of a vesicovaginal fistula are prior pelvic surgery or radiation therapy.
The most common symptom of a vesicovaginal fistula is incontinence or leakage of urine.  The leakage may range from mild to profound depending on the size and location of the urethra.
A vesicovaginal fistula may require several tests for diagnosis.  These involve a pelvic examination, likely cystoscopy as well as two possible dye tests.  You will also have an X-ray test to be sure the kidneys are not also affected as some patients may have both a vesicovaginal fistula and a ureterovaginal fistula (connected between the kidney tube(s) and the bladder.

Treatment options depend on several things including your medical condition/history, the cause and the location of the stricture.  Options for repair include a vaginal or an abdominal approach.  The goal of either approach is to excise or close the fistula tract and put healthy tissue in between the bladder and vaginal to help prevent the fistula from recurring. 

A vaginal vesicovaginal fistula repair is done through an incision in your vagina.  It involves removing the entire fistula with the surrounding scar tissue and then closing the hole in several layers.  The surgery takes approximately three hours and can be done under spinal or general anesthesia.  There are no stitches or bandages that have to be removed.  All the stitches will dissolve on their own. 

We do need to have a catheter draining your bladder for 3 weeks following the repair to allow the urethra to heal.  We usually use a foley catheter (a catheter placed via your urethra), but may sometimes opt to use a suprapubic tube (the catheter is placed in your bladder via your lower abdomen right above your pubic bone).