Dr. Pawan lal
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.
Classification
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
- Traumatic
- Postsurgical - Abdominal or vaginal hysterectomy
- External trauma (e.g., penetrating, pelvic fracture, sexual assault)
- Radiation therapy
- Advanced pelvic malignancy
- Foreign body
- Obstructed labour
- Uterine rupture
- Caesarean section injury to bladder
- Congenital
Presentation
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.
Management
The operative techniques are described as Abdominal or vaginal approaches
Abdominal Approach (O'Connor's Technique)
Vaginal approach
Below is the surgery of repair of a large Vesico Vaginal Fistula with the abodominal (O'Connor's Technique).
Diagrammatic representation of Vesico-Vaginal Fistula
