Vesico-Vaginal Fistula(VVF) &
Uretero-vaginal fistula(UVF)
A Vesico-Vaginal Fistula (VVF) is an abnormal connection between the bladder and the vagina, resulting in continuous involuntary discharge of urine into the vaginal vault.
Causes
Obstetric Causes:
Prolonged and obstructed labor.
Injuries during childbirth.
Surgical Trauma:
Complications from gynecological or pelvic surgeries, such as hysterectomy.
Radiation Therapy:
Damage from radiation treatment for pelvic cancers.
Infections:
Severe infections or inflammations, like tuberculosis.
Trauma:
Pelvic fractures or other severe injuries.
Symptoms
Continuous leakage of urine from the vagina.
Recurrent urinary tract infections.
Vaginal irritation and discomfort.
Foul-smelling vaginal discharge.
Skin irritation or excoriation in the perineal area.
Diagnosis
Medical History and Physical Examination:
Detailed history of symptoms and any recent surgeries or childbirth.
Pelvic examination to identify the source of leakage.
Dye Tests:
Instillation of dye into the bladder and observing its leakage through the vagina.
Cystoscopy:
Visual examination of the bladder and urethra using a cystoscope.
Imaging Studies:
Pelvic ultrasound, CT scan, or MRI to assess the anatomy and location of the fistula.
Treatment Options
Conservative Management:
Small fistulas may heal spontaneously with continuous bladder drainage using a Foley catheter.
Surgical Repair:
Transvaginal Repair: Accessing the fistula through the vagina to close the abnormal connection.
Transabdominal Repair: Accessing the fistula through an abdominal incision, often for larger or more complex fistulas.
Laparoscopic or Robotic Repair: Minimally invasive techniques to repair the fistula.
Tissue Interposition:
Using a piece of tissue (such as omentum or muscle) to reinforce the repair and prevent recurrence.
Uretero-Vaginal Fistula
A Uretero-Vaginal Fistula is an abnormal connection between a ureter (the tube that carries urine from the kidney to the bladder) and the vagina, resulting in continuous involuntary leakage of urine from the ureter into the vagina.
Causes
Surgical Injury:
Complications from pelvic surgeries, especially hysterectomies or surgeries for cancer.
Radiation Therapy:
Damage from radiation treatment for pelvic cancers.
Obstetric Trauma:
Injuries during difficult childbirth.
Infections and Inflammation:
Severe infections or inflammatory conditions affecting the ureter and surrounding tissues.
Symptoms
Continuous leakage of urine from the vagina.
Recurrent urinary tract infections.
Vaginal irritation and discomfort.
Flank pain (if the ureter is obstructed).
Diagnosis
Medical History and Physical Examination:
Detailed history of symptoms and any recent surgeries or childbirth.
Pelvic examination to identify the source of leakage.
Dye Tests:
Instillation of dye into the bladder and observing its leakage through the vagina.
Cystoscopy and Ureteroscopy:
Visual examination of the bladder, urethra, and ureters using endoscopic tools.
Imaging Studies:
Intravenous pyelogram (IVP), CT urogram, or MRI to visualize the urinary tract and identify the fistula.
Treatment Options
Conservative Management:
Continuous bladder drainage using a Foley catheter to promote spontaneous healing (rarely effective for uretero-vaginal fistulas).
Surgical Repair:
Reimplantation of the Ureter: Reconnecting the affected ureter to a different part of the bladder.
Laparoscopic or Robotic Repair: Minimally invasive techniques to repair the fistula.
Tissue Interposition: Using a piece of tissue (such as omentum or muscle) to reinforce the repair and prevent recurrence.
Post-Treatment Care
Bladder Drainage: Use of a catheter to allow the surgical site to heal.
Antibiotics: To prevent or treat infections.
Follow-Up Examinations: Regular monitoring to ensure the fistula has healed and to manage any complications.
Complications
Recurrence of the Fistula: The fistula may reopen after treatment.
Infections: Recurrent urinary tract infections.
Urinary Incontinence: Leakage of urine may persist in some cases.
Stricture Formation: Narrowing of the ureter or urethra at the site of the repair.
Conclusion
Vesico-vaginal and uretero-vaginal fistulas are challenging conditions that significantly impact a woman's quality of life. Early diagnosis and appropriate treatment are crucial for effective management.
Dr. Saurabh Mishra and his team are dedicated to providing comprehensive care for patients with these conditions, offering a range of surgical and non-surgical treatments to ensure the best possible outcomes.