Vesicovaginal fistula(VVF) - 1

One of the most common causes of urinary incontinence in females is vesicovaginal fistula(VVF). This is most common type of genitourinary fistula.

Definition:

This is a communication between the bladder and the vagina which will lead to escape of urine into the vagina leading to true incontinence.

Etiology:

Both obstetrical and gynecological causes can lead to vesicovaginal fistula.

Obstetrical causes:

Obstetrical causes are responsible for 80 to 90% cases of vesicovaginal fistula in developing countries and 5 to 15% cases in developed countries.

1. Obstructed labor: in case of obstructed labor because of prolonged compression on the bladder base between fetal head and symphysis pubis, ischemic necrosis occurs. Because of this decreased blood supply infection super imposes which will lead to sloughing of tissue resulting in fistula. In this case fistula can develop in 3 to 5 days.

2. Difficult labor: when baby delivery becomes difficult due to big baby or contracted pelvis etc, instrumental delivery may be needed. If forceps are applied especially Kielland forceps, the chances of injury to the bladder is more. 

3. Destructive procedures: in case of difficult labors if baby dies, to take out the baby destructive procedures like craniotomy may be needed. In this case trauma may be caused by instruments used or because of bony spicules of fetal head.

4. Emergency surgeries: in cases of emergency cesarean section for prolonged or obstructed labor, as the bladder will be drawn up in these cases chances of injury is high.

In case of cesarean hysterectomy for rupture uterus the chances of bladder injury is high as here also prolonged labor may led to drawn up bladder.

5. Repeat cesarean section:  because of adhesions caused by previous cesarean section between the bladder and the lower part of uterus, the chances of bladder injury are high.