A fistula is a connection between two spaces that should not be there. Occasionally fistulas are caused by an inflammatory process. A vesicovaginal fistula is an abnormal tract between the vagina and the bladder.
This type of fistula usually occurs after hysterectomy. In most cases, there was a bladder injury during the hysterectomy that resulted in a tract between the bladder and the vaginal cuff. Symptoms of a vesicovaginal fistula is primarily large volume urinary leakage through the vagina (not associated with an urge to void or stress such as coughing or sneezing). There may also be an increase invaginal discharge or bleeding.
Repair is sometimes done vaginally, but most often done robotically. If done vaginally, a labia majora flap is used to keep the vaginal repair and bladder repair separated following the surgery. If robotic, the sigmoid mesentery (a fold of peritoneum) is used. In both procedures, the fistulous tract is excised and the bladder and vagina are closed separately, with the interposition.
To learn more, here’s the perspective of a patient who underwent the procedure, and determined the results were well worth it!
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