A fistula is an abnormal passage between an organ and body surface or between two organs. Specifically, a vesicovaginal fistula is an abnormal passage between the bladder and the vagina.
In the United States, the most common cause of a VVF is injury to the bladder at the time of gynecologic, urologic, or other pelvic surgery. Other causative factors include pelvic radiation, malignancy or other trauma. In the developing world, VVF most commonly occur due to prolonged and obstructed labor where the baby’s head may be disproportionately large for the mother’s pelvic outlet.
A full evaluation requires a pelvic examination. Cystoscopy, where a small camera is placed into the bladder, will be performed to localize the fistulous tract. Many times, imaging with a voiding cystourethrogram and CAT scan will be performed to visualize the bladder and to ensure that there are no injuries of the ureters (tubes that connect the bladder to the kidney) or other fistulas present.
At UCLA Urology, we have mastered the techniques to address the most complex vesicovaginal fistulas.
Depending on the cause of the fistula, in rare cases, observation and prolonged foley catheter drainage with bladder rest may be selected for trial of spontaneous healing. However, in most cases, surgical repair is necessary to repair VVFs.