These are abnormal communication between the Vagina and the urinary bladder that causes continuous involuntary flow of the urine from the vagina. The cause of VVF is either due to birth canal injuries or malignancies (post-radiotherapy or direct infiltration of the the cancer). The commonest cause of the VVF in India is due to injuries sustained during delivery.
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, fistulas due to chronic diseases or radiotherapy and fistulas more than 2.5 cm in size.
Causes of Vesico-Vaginal Fistulas
The classical presentation sign is continuous (day and night) incontinence after a recent pelvic operation. If the fistula is small, then watery discharge from the vagina accompanied by normal voiding may be the only symptom. The patient may experience recurrent cystitis or pyelonephritis; unexplained fever; hematuria; flank, vaginal, or suprapubic pain; and abnormal urinary stream. Those with larger fistulas may not void transurethrally and may have total incontinence. Urinary leakage may make the patient a social recluse, disrupt sexual relations, and lead to depression, low self-esteem, and insomnia. The leakage of urine may cause irritation of the vagina and vulvar mucosa, and perineum and usually produces a foul ammonia odor.
The operative techniques are described as Abdominal or vaginal approaches
Abdominal Approach (O'Connor's Technique)
Below is the surgery of repair of a large Vesico Vaginal Fistula with the abodominal (O'Connor's Technique).
Left Radical Nephrectomy through thraco-adminal incision
Ureteroscopy (URS) and stone fragmentation is a well-established treatment for ureteral and renal stone disease. Infection and sepsis are recognized complications of URS that can result in significant morbidity and mortality1 . A positive preoperative mid stream sample of urine (MSSU) was the only factor significantly associated with postoperative urosepsis on multivariable analysis. Patients with a positive preoperative MSSU, despite being asymptomatic and receiving treatment with an appropriate preoperative course of antibiotics, were 4.88 · more likely to have postoperative urosepsis on multivariable analysis than those patients with a negative preoperative MSSU. The presence of diabetes mellitus, presence of ischemic heart disease, patient ASA score, undertaking same session bilateral procedure, and stone volume were the other variables significantly associated with post-operative infection1.
Abdominal (O'Connor) repair of large Vesico Vaginal Fistula