Vesico-Vaginal Fistula: Meaning, Causes, Prevention And Treatment

VESICO-VAGINAL FISTULA is an abnormal communication between the urinary bladder and the vagina that results in the continuous involuntary discharge of urine into the vaginal vault.
VESICO-VAGINAL FISTULA

CAUSES OF VESICOVAGINAL FISTULA (VVF)

Numerous factors contribute to the development of VVF in developing and developed countries.

Which are;

  • - Traumatic injury to the vaginal
  • - Postsurgical
  • • Abdominal hysterectomy
  • • Vaginal hysterectomy
  • • Anti-incontinence surgery
  • • Anterior vaginal wall prolapse surgery (e.g., colporrhaphy)
  • • Vaginal biopsy
  • • Bladder biopsy/endoscopic resection/laser
  • • Other pelvic surgery (e.g., vascular, rectal)
  • • External trauma (e.g., penetrating, pelvic fracture, sexual)
  • • Radiation therapy
  • • Advanced pelvic malignancy
  • •Infectious/inflammatory pelvic disease
  • • Foreign body
  • - Obstetric
  • • Obstructed labor
  • • Forceps laceration
  • • Uterine rupture
  •   Early child birth
  •   Sexual trauma
  •   Urologic and gynaecologyic instrumentation
  •   Early marriage
  •   Prolonged labour
  • • Caesarean section injury to bladder
  • • Congenital

There are also several risk factors that predispose a woman to VVF

Risk factors that predispose to VVFs include; prior pelvic or vaginal surgery, previous PID, ischemia, diabetes, arteriosclerosis, carcinoma, endometriosis, anatomic distortion by uterine myomas, and infection, particularly postoperative cuff abscess.

SIGNS AND SYMPTOMS 


  • Continuous urinary incontinence(day and night)
  •  Excessive vaginal discharge
  •  Fever
  •  Pain
  •  Foul smell


DIAGNOSTIC INVESTIGATION

Physical examination: Physical examination is of vital importance. The site of the fistula and its surroundings must be thoroughly observed.

If there are signs of associated acute inflammation, edema, necrosis, or other bladder pathologies coexist, then surgery should be postponed until these problems are resolved.

In the preoperative planning, any scar at the site of the fistula, fixation to adjacent organs, rigidity of the vagina, or post-irradiation involvement of the rectum may change the surgical approach.

Cystoscopy: Cystoscopy is also of particular help and can clarify the exact anatomic origin. For small fistulas, it may be helpful to attempt to pass a small ureteric catheter through the suspected fistula tract to determine if it enters the vagina.

Intravenous pyelography: An intravenous pyelography is also recommended to rule out concomitant ureteral fistulas before proceeding with the surgical repair.

TREATMENT MANAGEMENT OF VESICO-VAGINAL FISTULA

The major aim of treatment is to repair the damage wall and ensure closure.

1) SURGICAL MANAGEMENT: Treatment of patients with VVF must embrace their immediate and, in most cases, subsequent surgical management most be done.

2) NUTRITIONAL CARE: It is vital to consider the nutritional and rehabilitative needs of patients. When a delayed approach to surgery is intended, adequate diet should be given to patient most especially protein and vitamins which helps in repair of damage tissue.

3) PHYSICAL CARE: it is essential to take care of the sanitary protection and the skin of patient in order to prevent pressure sore and infection.

PREVENTION OF VESICO-VAGINAL FISTULA

1) Abnormal cultural practices should be eradicated e.g Female genital mutilation
2) Early child marriage and birth should be eradicated
3) Skilled birth attendants should be made available
4) Pelvic inflammatory disease and pelvic trauma should be treated early
5) Women should be advised to go government accredited hospitals to deliver
6) Women should also be advised to attend antenatal clinic during the period of pregnancy
7) Government Should create more awareness on the causes of VVF
8) Government should make available facilities that would help in early diagnoses and treatment.

COMPLICATION OF VESICO-VAGINAL FISTULA

1) Recurrence of fistula
2) vaginal/ urinary tract infection
3) Abscess

Find This Helpful?

1 comment:

Hey Friend! This conversation is missing your voice. Drop your comment before you go. #Winks