A Family Doctor's Tale - VESICOVAGINAL FISTULA

DOC I HAVE A VESICOVAGINAL FISTULA

Vesicovaginal Fistula is a chronic granulous track which communicate between the bladder base and the vagina.

Vesicovaginal Fistula usually result from :
1.operation through the vagina causing a hole through vaginal wall to bladder wall

2.follows surgery for hysterectomy

3.Pressure necrosis on the vaginal and bladder walls during a
prolonged and difficult labor.

4.Radiation burns during treatment of cancer of cervix

5.untreated cancer of bladder or genital tract in women

6.Chronic illness such as tuberculosis of bladder or genital tract in women

7.Congenital fistula between bladder and vagina

A veiscovaginal fistula have a natural tendency to close by granulation and fibrosis.

Factors interfering with this are:

1.continual flow of urine

2.sepsis

3.persistance of causative factor such as malignancy or radiation necrosis.

However if the urinary stream can be diverted by a cathether and good bladder drainage and if the sepsis is treated, the natural decrease in size will occur.

Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months

Symptoms:
1.incontinence

2.painful urination

3.frequent urination

4.vaginal discharge or wetness

5.painful vagina

Diagnosis:
1.Vaginal examination can show presence of fistula on the roof of vagina

2.Dye instilled into the bladder shows the dye leaking from the roof of vagina

3.Intravenous pyelogram also can show the contrast leaking into the vagina on X-ray.

Treatment of small fistula:
1.The urinary stream can be diverted by a cathether and good bladder drainage

2.The sepsis is treated with antibiotics
Without infection and the constant leakage of urine, the fistula will naturally decrease in size.

Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months

3.If this does not happened, the fistula can be easily stitched up.

Treatment of larger fistula:
The vaginal skin is cut open bigger than the fistula for the fresh edges to be stitched.

The granulated hardened edges of the original fistula will not join together so easily as when fresh new tissues are cut and stitched together.

A catheter is left in the bladder to drain the urine and antibiotics are given to prevent infection.

Painkillers may be given if there is pain after the operation.

General treatment:
1.Treatment of associated diseases like diabetes,  carcinoma

2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed

3.toilet and dressing of the wounds, with application of antibiotic creams

4.tub baths of the Vesicovaginal region several times a day in plain, warm water for about 10 minutes

Prognosis is good with surgery.
Rarely there may undesirable complication like urinary incontinence.