Vesico-Vaginal Fistula

In medical term a fistula means a hole and vesico-vaginal fistula means a hole between the vagina and the bladder. This hole is a tiny perforation which results in continuous leakage of urine into the vagina causing urinary incontinence.

What are the Causes?

The vesico-vaginal fistula is a complication of a gynecologic surgery. The bladder which lies above the vagina can get damaged during surgery to the vagina. Hysterectomy (removal of the uterus), surgery to repair bladder prolapse, and sling procedures to treat urinary incontinence can result in damage to the bladder.

Fistula can also be caused by radiotherapy to treat cancer in the pelvic region. Radiotherapy has a prolonged effect on the area of treatment and a fistula can form even many years after radiotherapy. A difficult labour during childbirth can also be the cause of a fistula formation where advanced obstetric care is not administered.

What are the symptoms?

Continuous dribbling of urine through the vagina

What are the treatment options available?

A fistula can be closed surgically; however, it is not necessary to rush into surgery to treat a bladder fistula.  Placement of a catheter inside the bladder can heal the fistula, especially if it is a complication of a surgery.

If the fistula does not heal by conservative measures and surgery is the only option, then it is important to let the inflammation settle before any surgical intervention. Surgery through a vaginal route is sufficient to close a small fistula, however, a larger fistula will need extensive reconstruction through a vaginal as well as an abdominal route.  In severe cases when there is irreparable damage to the bladder due to radiation, a urinary diversion method is used to drain the urine out from the body and a new bladder is created from a part of intestine.