In medicine, a fistula is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation.[3] Fistulas are generally a disease condition, but they may be surgically created for therapeutic reasons.
There are different types of fistulas, but we're going to learn about Vesicovaginal fistula in this article.
Vesicovaginal Fistula, or VVF, is an abnormal fistulous (fistula: abnormal passaage way or connection) tract extending between the bladder (or vesico) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
In addition to the medical sequelae (a condition caused by an earlier disease or problem) from these fistulas, they often have a profound effect on the patient's emotional well-being.
According to the United Nations Population Fund (UNFPA), there are three delays that contribute to the development of a fistula: delay in seeking medical attention; delay in reaching a medical facility; and delay in receiving medical care once arriving at a health care facility.
The United Nations Fund for Population Activities (UNFPA) says that every year about 800,000 women suffer from Vesico Vaginal Fistula (VVF) in Nigeria.
A violent rape can also cause a vesicovaginal fistula.
Signs & Symptoms of VVF
The symptoms of a vesicovaginal fistula include the constant dripping of urine from the vagina. It can be as little as a few drops or as much as a stream depending on how large the hole is. The vulva and vagina become irritated by the constant wetness and there can be redness and pain in the vaginal or vulva area.
Other signs of VVF include;
Having an infection or sore in your vagina area
Having severe abdominal pain or irritability of the bladder
Experiencing urine leakage within the first 24-48 hours after a traumatic childbirth
If you notice any of these symptoms do not hesitate to visit your doctor who will ask you about your symptoms and about any surgery, trauma, or disease that could have caused a fistula.
Causes
It is often caused by childbirth (in which case it is known as an obstetric fistula), when a prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize (die), leaving a hole.
Vaginal fistulas can also result from violent rape. Some health centers in countries such as the Democratic Republic of Congo have begun to specialize in the surgical repair of vaginal fistulas.
It can also be associated with hysterectomy,cancer operations, radiation therapy and cone biopsy.
Repair and treatment of Vesicovaginal fistula
The treatment of a vesicovaginal fistula is usually surgical depending on various factors including size and location of the fistula, timing from the event that caused it, and how severe the symptom is, quality of surrounding tissue, and the experience of the doctors and their surgical skills.
Vesicovaginal fistulae are typically repaired either transvaginally or laparoscopically, although patients who have had multiple transvaginal procedures sometimes attempt a final repair through a large abdominal incision, or laparotomy.
The laparoscopic (minimally invasive) approach to VVF repair has become more prevalent due to its greater visualization, higher success rate, and lower rate of complications.
Possible Complications of Surgical Treatment
Recurrent formation of the fistula
Injury to ureter, bowel, or intestines
Vaginal shortening.
Fortunately, the diagnosis and surgical management of vesicovaginal fistulas is associated with high cure rates if performed by well trained surgeons.
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