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Repair of Vesico-Vaginal Fistula

Authors:
  • Deanna M. Neff, MPH
Publication Type:

Procedure

Repair of Vesico-Vaginal Fistula

Definition

A vesico-vaginal fistula is a link between the urinary tract and the vagina that should not be there. The repair will separate the organs.

The Urinary Tract.

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Reasons for Procedure

This type of fistula can cause urine to leak uncontrolled through the vagina. It can also be painful and raise the risk of infections. Surgery will close the fistula to stop symptoms.

Possible Complications

Problems are rare, but all procedures have some risk. Your doctor will go over problems that could happen, such as:

  • Urinary tract infection or other infections
  • Irritation or swelling of the vulva (the opening of the vagina)
  • Injury to bladder, vagina, or urethra (the tube that carries urine outside of the body from the bladder)
  • Bleeding
  • Bad reaction to anesthesia

The risk of problems may be higher in those who:

  • Smoke
  • Drink alcohol
  • Have long term health issues such as diabetes or obesity

The risk of problems with a fistula repair may also be higher with:

  • Blood-thinning medicines
  • Large or complex fistulas

What to Expect

Problems To Look Out For

Call your doctor if you have:

  • Increasing pressure or pain
  • Redness, soreness, bleeding, or discharge at or around the incision site
  • Changes in how often you urinate
  • Changes in the urine amount, odor, how it looks, or there is a lot of blood in the urine
  • Not been able to urinate
  • Signs of infection, including fever or chills

If you think you have an emergency, call for medical help right away.

Prior to Procedure

The care team may meet with you to talk about:
  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery
  • Specialists you may need to see
  • Tests that will need to be done before surgery

Prior to Procedure

The care team may meet with you to talk about:
  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery
  • Specialists you may need to see
  • Tests that will need to be done before surgery

Anesthesia

General anesthesia will keep you asleep during the procedure.

Description of the Procedure

The surgery can be done through the vagina or through an incision in the belly. A scope may also be passed through the urethra into the bladder.

Transvaginal

A small tube will be inserted into the urethra. A speculum will also be used to open the vagina. The doctor will find the fistula. The walls of fistula will be cut away. The area will then be closed with sutures. Special dressings may be placed in the vagina.

Transabdominal

A small incision will be made in the lower belly. The doctor will find the fistula. The fistula lining will be cut and removed. The tissue will be moved to disconnect the urinary tract and vagina. The vaginal wall and wall of the urinary tract will then be closed. The wall of the belly will be closed.

Immediately After Procedure

A tube may placed be in the urethra to drain the bladder. It will be taken out some time after you wake up.

How Long Will It Take?

1 to 3 hours or more if the surgery is more complicated

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medicines.

Average Hospital Stay

This procedure is done in a hospital. The usual length of stay is:

  • 1 to 2 days for a simple repair
  • 3 to 5 days for a complex repair

Post-procedure Care

At the Hospital

After the procedure, the hospital staff may do the following:

  • Watch you while you wake up from the anesthesia.
  • Help you slowly start to eat and move around.
  • Give you pain medicine.
  • Take care of your catheter. The catheter will likely be in place for several weeks.
During your stay, the hospital staff will take steps to lower your risk of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered.
There are also steps you can take to lower your risk of infection, such as:
  • Washing your hands and reminding visitors and staff to do the same
  • Reminding staff to wear masks or gloves
  • Not letting other touch your incisions

At Home

Some activity will need to be avoided until the area has healed.

RESOURCES:

CANADIAN RESOURCES:

CANADIAN RESOURCES:

References

  • Jatoi, N., Jatoi, N., et al. Key to successful vesico-vaginal fistula repair: an experience of urogenital fistula surgeries and outcome at gynecological surgical camp 2005. Ayub Medical College website. Available at: http://www.ayubmed.edu.pk/JAMC/PAST/20-2/Nasreen.pdf.
  • Tavares, M.A., Campagne Lpiseau, S., et al. Intravesical repair of vesicovaginal fistula guided by cytoscopy. Facts, Views & Vision in ObGyn, 2021; 13 (2): 175-178,
  • Vesicovaginal fistula. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/vesicovaginal-fistula.

Contributors

  • Chelsea Skucek, MSN, BS, RNC-NIC
Last Updated:
2022-11-01

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.