Repair of vesicovaginal fistula

1. What is it? Any common name for this procedure?

A Vesicovaginal Fistula (VVF) is an abnormal, tunnel-like opening that forms between the urinary bladder and the vagina. This results in continuous, involuntary leaking of urine into the vaginal vault.

VVF Repair is the surgical procedure to close this tunnel, separate the two organs, and restore the integrity of both the bladder and the vaginal wall.

Common Names:

• Fistula Repair
• Vaginal Fistula Surgery
• Bladder-Vaginal Repair

2. Common Indications: When is it Recommended?

VVF repair is recommended whenever a fistula is diagnosed, as they rarely heal on their own once fully established.

• Continuous Urinary Leakage: Constant "dripping" or wetness that occurs without any urge or physical stress.
• Post-Surgical Complication: Often occurring after a difficult hysterectomy or other pelvic surgeries where the bladder wall was accidentally injured.
• Obstructed Labor Injury: In some regions, prolonged or difficult childbirth can cause tissue death (necrosis), leading to a fistula.
• Radiation Injury: A delayed side effect following radiation therapy for cervical or uterine cancer.

3. List of Associated Risks and Conditions

• Recurrence: The fistula may reopen if the tissue does not heal properly, particularly in cases caused by radiation.
• Ureteral Injury: Because the ureters (tubes from the kidneys) enter the bladder near common fistula sites, they are at risk during the repair.
• Reduced Bladder Capacity: If the fistula was large, the bladder may be slightly smaller after it is sewn back together.
• Vaginal Shortening: Depending on the surgical approach, there may be slight changes to the vaginal canal.

4. List of Screening Tests and Assessment Tools

5. Am I Eligible for This Evaluation?

1. Confirmed Diagnosis: Clear evidence of a tract between the bladder and vagina.
2. Healthy Tissue: The surrounding tissue must be free of active infection or severe inflammation. Surgeons often wait 3 to 6 months after the initial injury to allow inflammation to settle before attempting a repair.
3. Cancer-Free: If the fistula was caused by a tumor, the cancer must be treated or ruled out before the repair.
4. Nutritional Status: Good general health is required to ensure the surgical "flap" or sutures heal correctly.

6. Surgical Approaches

• Vaginal Approach (Latzko Technique): The repair is done entirely through the vaginal opening. This is less invasive and has a faster recovery time.
• Abdominal Approach: Used for complex or high-set fistulas. It involves an incision in the lower belly.
• Laparoscopic/Robotic Repair: A "keyhole" version of the abdominal approach, offering high precision and faster healing.
• Tissue Interposition (Flaps): For difficult repairs, a piece of fat (Martius flap) or muscle may be placed between the bladder and vagina to act as a "buffer" and improve healing.

7. Days Required for Hospitalization

• Surgical Time: 2 to 4 hours.
• In-Hospital Stay: 2 to 4 Days. Patients stay to ensure they are comfortable and the catheter is draining properly.
• Catheter Time: A urinary catheter is usually required for 10 to 14 days to keep the bladder empty and allow the repair site to heal without pressure.
• Hospitalization: 2–4 Days.

8. Benefits of VVF Repair

• Restoration of Continence: Stops the continuous leaking of urine, allowing the patient to return to a dry, normal life.
• Skin Health: Eliminates the constant moisture that causes painful vaginal and vulvar skin irritation (excoriation).
• Social Reintegration: Removes the odor and hygiene challenges associated with a fistula, restoring confidence and social comfort.

Sexual Health: Resolves the physical barrier to comfortable and hygienic sexual intercourse.