Vesicovaginal Fistula
INTRODUCTION:
- Vesicovaginal fistula may present days to weeks after the initial inciting surgery, and those following hysterectomy typically present at 1 to 3 weeks.
- Most common genital fistula in India
- It classically presents with unexplained continuous urinary leakage from the vagina after a recent operation.
- Other less specific symptoms of genitourinary fistula include fever, pain, ileus, and bladder irritability.
- Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).
- VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault
ETIOLOGY:
- Obstructed labour(common)
- Rupture of uterus
- Cesarean section
- Kielland forceps can injure the bladder during rotational delivery
- Abdominal hysterectomy for PID, endometriosis and cervical fibroid
- Radiotherapy cause bladder fistula few months to 2 years due to ischemic vascular necrosis
- TB, cancer of lower genital tract, and rarely a bladder stone and perforated IUCD
SYMPTOMS:
- Dribbling of urine occurs after varying interval following delivery (5-7 days)
- Vesicovaginal fistula by obstructed labour manifests After 1st week of delivery
- unexplained continuous urinary leakage from the vagina
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Other less specific symptoms of genitourinary fistula include fever, pain, ileus, and bladder irritability.
DIAGNOSIS:
- Triple swab test is the investigation of choice to establish the diagnosis of a suspected vesico vaginal fistula.
- It confirms the presence of vesico vaginal fistula, and also differentiate it from uretero vaginal and urethro vaginal fistula.
- The most valuable investigation in an established case of a vesicovaginal fistula should be cystoscopy.
- Foley’s catheter is the most appropriate method for collecting urine for culture
TREATMENT:
- Conservative method:(waiting for spontaneous rupture)by prolong catheter is useful in small fistulas.
- Surgical method: (in most cases): by vaginal or abdominal approach
- Vesicovaginal fistula repair surgery, the drainage should be done for 14 days
Exam Important
- The most appropriate method for collecting urine for culture in case of vesicovaginal fistula is Foley’s catheter
- Vesicovaginal fistula repair surgery, the drainage should be done for 14 days
- Vesicovaginal fistula by obstructed labour manifests After 1st week of delivery
- A 52 year old lady presents with constant leakage of urine and dysuria two weeks after a complicated total abdominal hysterectomy diagnosed of Vesicovaginal fistula is suspected. The most important test for the diagnosis is Triple Swab Test
- A 52 year old lady with a vesicovaginal fistula after abdominal hysterectomy is not responding to conservative management. Most useful and important next investigation is Cystoscopy
- Obstructed labour is the MOST common cause of vesicovaginal fistula in India
- Vesicovaginal Fistula is the Most common genital fistula in India
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