Dr. med. Dirk Manski



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Vesicovaginal Fistula

Definition

A vesicovaginal fistula is an abnormal passageway between the female urinary bladder and vagina with urinary incontinence.

Etiology of Vesicovaginal Fistula

Signs and Symptoms

Urinary incontinence (continuously day and night), loss of urine through the vagina, urinary tract infections.

Diagnostic Work-Up


Abb. cystoscopy of a vesicovaginal fistula

Cystoscopy: two different presentations of vesicovaginal fistulas. With kind permission of Dr. J. Schönebeck, Ljungby, Schweden.


Treatment of Vesicovaginal Fistula

Conservative Treatment:

A newly diagnosed vesicovaginal fistula after gynecological surgery may be cured by inserting an indwelling catheter for 3–4 weeks (success rate 10–50%). The success is difficult to predict in individual cases, indicators of a good prognosis are early diagnosis and therapy within 7 days, small fistulas of less than 1 cm in size, no loss of urine after inserting the bladder catheter, no previous radiation treatment or cancer surgery.

Timing of Surgical Treatment:

The time delay between fistula formation and surgical treatment is stressful for the patient. Nevertheless, surgery should be delayed for three months to allow healing of the inflammatory tissue reaction around the fistula. Vaginal estrogen application is recommended before surgery. Some authors recommend a delay of up to one year before repair of radiation therapy induced fistulas.

Vaginal Approach for the Repair of Vesicovaginal Fistulas:

Vaginal surgical techniques are possible for uncomplicated and small vesicovaginal fistulas. The main advantage of the vaginal approach is the low postoperative morbidity.

Surgical technique of the vaginal approach:

Abdominal Approach for the Repair of Vesicovaginal Fistulas:

The abdominal approach is more risky for the patient, but it is necessary for fistulas of more than 2 cm in size, after irradiation, after failed repair, if there is need for concomitant abdominal surgery (ureteral injury or intestinal fistula) or if a too narrow vagina hinders the vaginal approach.

Surgical technique of the abdominal approach:

Palliative Cystectomy for Vesicovaginal Fistula:

Cystectomy is an option in vesicovaginal fistula due to advanced tumor disease, or due to a contracted bladder after radiation therapy.







Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Chapple, C. & Turner-Warwick, R.
Vesico-vaginal fistula, BJU Int, 2005, 95, 193-214.


  Deutsche Version: Vesikovaginale Fistel