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
  • 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 Question of:
  • 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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