A vesicovaginal fistula occurs when a fistula (abnormal connection between two organs or between an organ and a body surface) connects the bladder to the vagina. The most common symptom is a constant dribbling of urine through the vagina. Many patients still void through their ureter. Other less common symptoms include:
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In some cases, vesicovaginal fistulas (as well as other vaginal fistulas) are often caused by sexual trauma to a young woman or a difficult childbirth. IHowever, vesicovaginal fistulas usually are the result of trauma from a medical procedure or disease. Here are some of the common causes:
The first step of diagnosis usually is a pelvic examination. Patients also receive a cystoscope exam which allows a small camera to visualize the inside of the bladder and locate the fistula. A CT scan and/or a voiding cystourethrogram are used to confirm the diagnosis and ensure that there are no other fistulas. Other tests include:
Occasionally, vesicovaginal fistulas may spontaneously heal with the continued use of a Foley catheter. It is sometimes possible to seal a small fistula with a substance made of proteins. If a fistula is small and not related to cancer or radiation treatments, a conservative approach may be all that is needed.
However, most vesicovaginal fistulas require surgery. Depending on the exact location, the surgery may be performed through the patient's vagina, known as transvaginal surgery, or through the abdomen. Surgeons might use laparoscopic surgery or robotically-assisted laparoscopic surgery.
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