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Vesicovaginal Fistula

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Introduction

When an unnatural opening develops between two internal organs of the human body, it is medically termed as a fistula. This fistula can be the result of an injury or infection, which causes inflammation. Vesicovaginal Fistula is the opening developed between the vagina and the urinary bladder of a woman. This is a severe medical condition that needs urgent attention and the best treatment to provide relief from the related symptoms.

If you find that urine is steadily leaking out of your vagina, the reason for this embarrassing condition may be detected to be Vesicovaginal Fistula (VVF). It is an abnormal tract that connects your vagina to your urinary bladder, leading to the continuous leakage of urine. Hence, this opening is also commonly called bladder fistula. The extent of this involuntary urine discharge depends on the size of this fistula. So, you need to see an experienced surgeon for the proper treatment of this problem, as surgery is the best option to close this undesired tract.

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What are the Causes of Vesicovaginal Fistula?

Surgery on the urinary bladder or vagina may lead to the formation of this fistula as a post-surgical problem.

  • ● An incident of rape can cause a hole in the vaginal wall, resulting in this medical condition.
  • ● A fistula may occur as the side effect of radiation therapy conducted to treat vaginal cancer.
  • ● Severe infections in the urinary tract can cause this type of fistula on the vaginal wall, mainly when a patient repeatedly suffers from such infection.
  • ● It may be a congenital problem that may occur if the baby is pressed against the mother’s pelvis due to prolonged labour.

What are the symptoms of Vesicovaginal Fistula?

The main symptom of the Vesicovaginal Fistula is the continuous urine leakage from the urinary bladder to the vagina.

  • ● Soreness in the vagina due to infection caused due to this fistula, which may increase to severe pain during intercourse.
  • ● High fever
  • ● Pain in the abdominal region
  • ● Feeling of nausea and vomiting in some cases.
  • ● Occasional diarrhoea
  • ● Consequent weight loss

How is Vesicovaginal Fistula Diagnosed?

  • ● A thorough urine test is conducted to check whether there is an infection causing your problem of urine leakage.
  • ● The common diagnostic test for vesicovaginal fistula starts by passing dilute methylene blue solution into your urinary bladder through a catheter. Then tampon or a soft material will be inserted into your vagina. The doctor will then ask you to move around for a few minutes for confirmation of the fistula.
  • ● Cystoscopy is a diagnostic procedure where the lining of your urinary bladder and the urethra are minutely examined. The doctor will insert a hollow tube fitted with a lens called a cystoscope through your urinary tract to the bladder for checking its condition.
  • ● There are some advanced diagnostic tests to confirm this type of fistula, like transvaginal sonography, vaginoscopy–cystoscopy, endocavitary ultrasound, and fistulography.

How is Vesicovaginal Fistula Treated?

Surgery is the only option for the treatment of Vesicovaginal Fistula. The surgeon will close the tract or fistula between your bladder and vagina by opening up the organs. Moreover, any other damage to the bladder can also be cured with this surgical procedure. He may apply the transvaginal or laparoscopic technique for this surgery, to repair this fistula and consequent problems in your bladder and vagina. You will need to keep a catheter inserted in your urinary tract for a couple of weeks, till you are completely cured.

What is the Results of Vesicovaginal Fistula Treatment?

Usually, there is no risky outcome of this surgery that is conducted to cure the Vesicovaginal Fistula. The surgeon will permanently close this abnormal opening between your bladder and vagina. So it is unlikely that you suffer from this problem ever again in the future. Moreover, this surgery has hardly any adverse side effect, except for a few weeks’ bed rest till the surgical wound is fully healed.

What are the Risk Associated with Vesicovaginal Fistula Treatments?

According to the latest information, more than three million women suffered from Vesicovaginal Fistula. All of them had undergone surgeries to get relief from this problem. These surgeries were reportedly successful and hardly caused any adverse effects on those patients.  In the USA, it is one of the most common surgeries conducted in all hospitals.

  • ● Some post-surgical complications may develop in the pelvic region of a patient, which can be cured with radiation therapy. However, such problems are too rare, and only 0.05 – 2% of the patients have reportedly suffered from such side effects of VVF.
  • ● A patient may need more time for healing if the size of her fistula is too large, or there is no interposition flap. A larger amount of tissues are damaged due to this fistula, and the patient takes longer for complete cure.
  • Diabetic patients also find it more difficult to heal the suture line and the wounded region caused by the VVF surgery.
  • ● Smoking is a vital factor that increases the risk of the failure of a VVF surgery, for which inhaling tobacco smoke is prohibited within one month of this surgery.
  • ● If a patient has undergone radiation therapy previously or if she suffers from chronic inflammation in the abdomen, the healing time may be much longer.

So patients are counselled about these risk factors before the VVF surgery, to make sure that they face no risk of the failure of this surgery.

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FAQ's

Is there Any Treatment Option Other than Surgery for Curing Vesicovaginal Fistula?

No, surgery is the only treatment for curing this type of Vaginal Fistula forever.

Can VVF Recur Even After the Surgery?

No, it is never heard that this kind of fistula has developed again after it is closed by surgery.

Is it Necessary to take Antibiotics Before or After VVF?

Your doctor will prescribe antibiotics only if you are suffering from any infection.

How Long Does the Patient Need to Use a Catheter After VVF Surgery?

Generally, it is recommended to use a catheter for at least three weeks after this surgery, to empty your bladder easily. A nurse will check the catheter at regular intervals to ensure it is not blocked.

How Much Fluid Intake is Essential After this Surgery?

A patient is advised to drink 200 – 300 ml of fluids every hour after the VVF surgery, to prevent infection and the blockage of her catheter.

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