Vesicovaginal & ureterovaginal fistula

What is a Vesicovaginal Fistula (VVF)?

A vesicovaginal fistula is a hole between the bladder and vagina. Depending on the size of the hole, the urine will drain continuously out the vagina, requiring multiple pullups or pads.

How does a VVF occur?

The most common cause for a VVF is bladder injury that occurs during a hysterectomy (uterus removal). Bladder injuries most commonly occur during open abdominal hysterectomies, followed by laparoscopic assisted vaginal hysterectomies. Bladder injury during a vaginal hysterectomy is very uncommon.

When does a VVF present?

Most VVF present within days of the hysterectomy. Initially, leakage from the vagina may be confused from peritoneal fluid that leaks from the vaginal cuff.

UVF is usually diagnosed by a CT urogram of the pelvis. If the ureter is not well visualized on the CT, then dye can be injected into the ureter through a telescope placed in the bladder. A UVF can also be suggested by the vaginal “pad test” used to diagnose a VVF – here the patient is given an oral medicine that stains the urine orange-red. If the vaginal gauze stains orange-red, then a UVF is typically also present.

Evaluation of the ureter is always part of the VVF evaluation.

• Vesicovaginal fistula. Also called a bladder fistula, this opening occurs between your vagina and urinary bladder and is the type that doctors see most often.
• Ureterovaginal fistula. This type of fistula happens when the abnormal opening develops between your vagina and the ducts that carry urine from your kidneys to your bladder (ureters).
• Urethrovaginal fistula. In this type of fistula, also called a urethral fistula, the opening occurs between your vagina and the tube that carries urine out of your body (urethra).
• Rectovaginal fistula. In this type of fistula, the opening is between your vagina and the lower portion of your large intestine (rectum).
• Colovaginal fistula. With a colovaginal fistula, the opening occurs between the vagina and colon.
• Enterovaginal fistula. In this type of fistula, the opening is between the small intestine and the vagina.

As with other minimally invasive procedures, patients who undergo minimally invasive surgery benefit in several ways:

• Shorter hospitalization
• Reduced pain and discomfort
• Faster recovery time and return to normal activities
• Smaller incisions, resulting in reduced risk of infection
• Reduced blood loss and transfusions
• Minimal scarring
• Most important of all, studies show that they may have better clinical outcomes.