Vesicovaginal fistula

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Presentation

Vesicovaginal Fistula, or VVF, is an abnormal fistulous tract extending between the bladder (or vesico) 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 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 violent rape. Some health centers in countries such as the Democratic Republic of Congo have begun to specialize in the surgical repair of vaginal fistulas.[1][2]

It can also be associated with hysterectomy,[3] cancer operations, radiation therapy and cone biopsy.

Repair of VVF

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.[4]

Possible Complications of Surgical Treatment

  • Recurrent formation of the fistula[5]
  • Injury to ureter, bowel, or intestines
  • Vaginal shortening

See also

References

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External links

no:Fistula

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  4. Miklos, JR. (2010, October 20). Fistula Repair Overview. Fistularepair.com. Retrieved September 11, 2013, from http://www.fistularepair.com/overview.php
  5. Laparoscopic Management of Recurrent Vesicovaginal Fistula - J.R. Miklos, C. Sobolewski and V. Lucente. Lehigh Valley Hospital, Allentown, Pennsylvania, USA.