Vesico Vaginal Fistula

VVF (Vesico-Vaginal fistula)

VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.

If VVF is diagnosed within the first few days of surgery, a transurethral or suprapubic catheter should be placed and maintained for up to 30 days. Small fistulas (< 1 cm) may resolve or decrease during this period if caution is used to ensure proper continuous drainage of the catheter.

The best chance for a surgeon to achieve successful repair is by using the type of surgery with which he or she is most familiar. Techniques of repair include :

  • the vaginal approach
  • the abdominal approach
  • electrocautery
  • fibrin glue
  • endoscopic closure using fibrin glue with or without adding bovine collagen, (6) the laparoscopic approach
  • using interposition flaps or grafts.

Vaginal approach:
Minimal blood loss, low postoperative morbidity, shorter operative time, and shorter postoperative recovery time are characteristics of the vaginal approach, making it an attractive option. Additionally, the vaginal approach obviates bowel manipulation, reducing operative morbidity, particularly in patients with radiation-associated fistulas..