Vesicovaginal Fistula

The vesicovaginal fistula is the most common of all of the vaginal fistulas.

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:

• The genital area may burn or sting from the constant flow of urine.
• Personal hygiene may become a problem.
• Painful intercourse is possible.
• Urinary tract infections may occur.

Causes

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:

• Pelvic surgery, such as a hysterectomy
• Cancer of the cervix, vagina or bladder
• Pelvic radiation for cancer
• Episiotomy or tear during childbirth
• Injury caused by an automobile accident or other serious accident

Diagnosis

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:

• Dye is inserted into the bladder and the patient is asked to cough or bear down. Dye-stained urine will appear in the vagina or on a tampon.
• Retrograde pyelogram uses contrast to visualize the kidneys, ureters, and bladder to see if there are any leaks between the ureters and the vagina.
• Fistulogram (an X-ray of a patient's fistula).
• MRIs use a magnetic field combined with radio waves to detail soft tissues within your body.
• Computerized tomography (CT) urogram is a specialized CT scan utilizing dye to obtain detailed cross-section images of the area between the bladder and the vagina.

Treatment

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.