Symptoms of Vesicovaginal fistula (VVF) : 

1. Continuous escape of urine through vaginam is the classic symptom.
2. NO urge to pass urine.
3. Intermittent leakage of urine.
4. Pruritus vulvae.
5. On vulval inspection :

•  Escape of watery discharge per vaginal of ammoniacal smell is characteristic.
• . Evidence of sodden and excoriation if the vulval skin.
• . Varying degrees of perineal tear may be present.

6. On internal examination : If the fistula is big enough its position, size and tissue at the margins are to be noted.

7. Onspeculum examination : The size, site and number of fistula

Investigation of Vesicovaginal fistula : 

1. EUA
2. Three cotton swab test
3. Dye test.
4. Metallic catheter test.

Treatment of Vesicovaginal fistula : 

Preventive : 

• .Adequate antenatal care is to be extended to screen out at risk mothers likely to develop
• . Anticipation, early detection and ideal approach in the method of delivery in relieving the obstruction.
• . Continuous bladder drainage for a variable period of about 5-7 days following deliver either vaginal or abdominally in a case of long – standing obstructed labour.
• .Care to be taken to avoid injury to bladder during pelvic surgery obstetrical or gynaecological.

Immeddiate management : Once the diagnosis is made, continuous catheterization for 6-8weeks is maintained. THis may help spontaneous closure of the fistula tract.

Operative : 

.Vaginal route : 

• . Flap splitting method
• .Saucerization
• .Colpocleisis : Partial, Total

. Repair by graft : 

• Vulval fat pad graft
• .Gracilis muscle graft.
• Omentum graft.

Abdominal route : 

• Transvesical
• . Transperitoneal
• . Combined..