Vesicovaginal fistula (VVF)

Vesicovaginal fistula (VVF)

Define Vesicovaginal fistula (VVF) : Abnormal communication between the bladder and the vagina and the urine escapes into the vagina causing true incontinence is called vesico- vaginal fistula.

We have described :

Management of Vesicovaginal fistula

Clinical feature of Vesicovaginal fistula

Investigation of Vesicovaginal fistula

Treatment of Vesicovaginal fistula

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..

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