Vesicovaginal Fistula: Diagnosis and Management

Abstract

Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. It represents a significant morbidity in female urology. Continual wetness, odor, and discomfort cause serious social problems. The diagnosis of the condition has traditionally been based on clinical methods and dye testing. A successful repair of such fistulas requires an accurate diagnostic evaluation and timely repair using procedures that exploit basic surgical principles and the application of interposition flaps. The method of closure depends on the surgeon's training and experience. The main complication of VVF surgery is recurrent fistula formation.

Factors Influencing Repair Outcomes of Vesicovaginal Fistula: A Retrospective Review of 139 Procedures

“…In our study, the overall success rate of VVF repair was 85.6%, comparable to that in previous reports [6,8,9] . We focused on the potential prognostic factors that were discussed in prior investigations.…”

“…to 100% regardless of through abdominal or vaginal approach [6,8,9] . In fact, the optimum approach for repair is still disputable.…”

Transvaginal primary layered repair of iatrogenic vesicovaginal fistula

“…The diagnosis of VVF is based on the observation of urinary leakage from the vagina, potentially after filling the bladder with dyed solution. Cystoscopy is useful in identifying the exact location of the fistula; additional diagnostic tools include computed tomography urography, magnetic resonance fistulography, and endocavitary ultrasonography . Small fistulas can be treated conservatively through continuous urethral catheterization for 0.5–2 months or electrocoagulation of the mucosal layer, potentially followed by fibrin sealant usage .…”

Reply to the letter to the editor

“…The presence of an abnormal communication between the vagina and urinary bladder/urethra would constitute a vesicovaginal or urethrovaginal fistula. An abnormal opening between the bladder and the vagina in a vesicovaginal fistula results in continuous and unremitting urinary incontinence [5]. The aetiology of vesicovaginal fistula includes congenital, obstetric, surgical, radiation, and malignant causes, the most common cause being obstructed labour.…”

“…The aetiology of vesicovaginal fistula includes congenital, obstetric, surgical, radiation, and malignant causes, the most common cause being obstructed labour. Vesicovaginal fistulas are classified as simple (≤0.5 cm), intermediate-sized fistulas (between 0.5 and 2.5 cm) and complex or large (≥2.5 cm) fistulas [5]. However, reflux of urine into the vagina from the urinary bladder and urethra without any abnormal defect in the walls may be described as vesicovaginal or urethrovaginal reflux, or more simply as vaginal reflux.…”