vesicovaginal

Vesicovaginal fistula refers to an abnormal, persistent communication between the urinary bladder and the vagina, through which urine leaks continuously into the vaginal canal. The term vesicovaginal is used to describe this relationship and is most commonly encountered as vesicovaginal fistula, the largest and most well-known form of genitourinary fistula in adult women.

Causes of vesicovaginal fistula include obstetric fistulas resulting from prolonged obstructed labor, which are more common in settings with limited access to timely obstetric care. Other causes include surgical injury during gynecologic procedures such as hysterectomy or cesarean section, pelvic radiation, trauma, and infections (for example tuberculosis) that erode tissue between the bladder and vagina.

Symptoms typically consist of continuous urinary leakage through the vagina, which can lead to skin irritation, recurrent urinary tract infections, vaginal discharge, odor, and significant psychosocial impact. The condition is diagnosed through a combination of pelvic examination and imaging studies to delineate the fistula’s location, size, and tract, including dye tests (such as a methylene blue test), cystoscopy, fistulography, CT urography, or MRI.

Definitive treatment is surgical repair, aiming to close both bladder and vaginal defects. Timing usually follows resolution of inflammation and infection. Approaches can be transvaginal or transabdominal, chosen based on fistula size and location, with layered closure and often an interposition flap (such as omental, Martius, or other tissue) to support healing. Postoperative bladder drainage with a catheter is typically required for 7–14 days. Prognosis is generally favorable in experienced centers, with success rates often above 80%, though recurrence can occur.

Prevention centers on preventing obstructed labor through access to quality obstetric care, timely cesarean delivery when indicated, and prompt management of any pelvic injuries or infections.