What is a vesicovaginal fistula?
A fistula is an unwanted opening that develops between two parts of the body. Causes of fistulas can include infections, injuries and inflammation. They can occur in many parts of the body.
A vesicovaginal fistula is an opening that develops between the bladder and the wall of the vagina. The result is that urine leaks out of the vagina, sometimes lightly but it can be steady if the fistula is large. In addition to being a serious medical problem, this condition is very upsetting. The leakage is embarrassing and can smell bad.
Symptoms and Causes
What causes a vesicovaginal fistula?
Vesicovaginal fistulas are often a complication after surgery to treat problems in the bladder or vagina. They also can be linked to gynecological cancer, either from the disease or sometimes as a side effect of radiation therapy or surgery to treat the cancer. Particularly bad or repeat urinary tract infections can sometimes lead to fistulas too, but this is rare.
Diagnosis and Tests
How are vesicovaginal fistulas diagnosed?
Most vesicovaginal fistulas develop soon after surgery and patients will complain of a lot of new urinary leakage.
Your provider will typically do a close physical exam of the area to learn more. Based on what they finds, imaging tests may be ordered. The most common tests would be an X-ray of the pelvis, or a computed tomography (CT scan) that uses dye (also called contrast) to highlight the tissues in that part of the body, making it easier to identify the source of the problem. The dye is injected through your vein or through a catheter inserted into the bladder. Your provider will probably also look in the bladder with a scope.
Management and Treatment
How are vesicovaginal fistulas treated?
The only way to fix vesicovaginal fistulas is with surgery to close off the opening. Sometimes additional procedures are needed to correct the original cause of the problem, such as damage to the bladder.
Surgery to correct vesicovaginal fistulas is generally very successful. Women who have a fistula due to a disease such as cancer may not have as good of an outcome, however.
Most women will need to have a catheter in the bladder for a few weeks while the surgical area heals.