Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).

Presentation

Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

('' vesica'') and the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

that allows the continuous involuntary discharge of

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...

into the vaginal vault. In addition to the medical

sequela A sequela (, ; usually used in the plural, sequelae ) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Derived from the Latin word, meaning “sequel”, it is used in the medical field to mean a complication ...

from these fistulas, they often have a profound effect on the patient's emotional well-being.

Causes

It may be the result of a congenital birth condition such as VACTERL association. It is often caused by childbirth (in which case it is known as an

obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may inc ...

), when a prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may

necrotize Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

(die), leaving a hole. Vaginal fistulas can also result from particularly violent cases of

rape Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or ag ...

, especially those involving multiple rapists and/or foreign objects. Some health centers in countries such as the Democratic Republic of Congo have begun to specialize in the surgical repair of vaginal fistulas. It can also be associated with

hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

, cancer operations, radiation therapy and

cone biopsy Cervical conization ( CPT codes 57520 (Cold Knife) and 57522 (Loop Excision)) refers to an excision of a cone-shaped sample of tissue from the mucous membrane of the cervix. Conization may be used for either diagnostic purposes as part of a biopsy ...

Treatment

Vesicovaginal fistulae are typically repaired either transvaginally or laparoscopically, although patients who have had multiple transvaginal procedures sometimes attempt a final repair through a large abdominal incision, or laparotomy. The laparoscopic (minimally invasive) approach to VVF repair has become more prevalent due to its greater visualization, higher success rate, and lower rate of complications.

Possible complications of surgical treatment

* Recurrent formation of the fistula * Injury to ureter, bowel, or intestines * Vaginal shortening

History

Before the 19th century, women who suffered from VVF were judged harshly and rejected by society. Throughout the 19th century, treatment for VVF was limited because the practice of gynecology was perceived as taboo. Doctors were almost entirely male at this time and looking at a nude female, even for medical purposes, was seen as divergent from 19th-century values. One of the most famous gynecological surgeons of this time was

Dr. J. Marion Sims James Marion Sims (January 25, 1813November 13, 1883) was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstruc ...

, who developed a successful technique for treating VVF in the mid-1800s, for which he is hailed as a pioneer of gynecology. Black enslaved women in the American South were particularly prone to VVF because they were denied proper nutrients and medical care. Sims performed on these women without anesthesia, which had not been introduced until after he started his experiments, and which in its infancy Dr. Sims hesitated to use. (Ether anesthesia was publicly demonstrated in Boston in 1846, a year after Sims began his experimentation.) Sims did not have a white female patient until he made ether available to them, although he publicly noted that he never resorted to using anesthetics because he believed that the pain did not justify the risks. A detailed case study of Dr. Sims even discusses the case of a white woman who underwent three operations, all without anesthesia. It was considered acceptable to operate on them without anesthetic because, Sims claimed, African-American women have a naturally higher pain tolerance. The healing process of the VVF procedure is still arduous. To have a successful recovery from the surgery, it must be successful on the first attempt. Dr. J. Marion Sims' operations on African-American enslaved women showcase the dangerous nature of the procedure. There still have not been clear instructions on how to properly recover from the procedure other than taking prescribed antibiotics.Stamatakos, M., Sargedi, C., Stasinou, T., & Kontzoglou, K. (2014). Vesicovaginal Fistula: Diagnosis and Management. The Indian Journal of Surgery, 76(2), 131–136. http://doi.org/10.1007/s12262-012-0787-y

References

External links

{{Diseases of the pelvis, genitals and breasts Noninflammatory disorders of female genital tract Fistulas J. Marion Sims no:Fistula