Within Our Walls: A Comprehensive Case Series on Vesicovaginal Fistula
DOI:
https://doi.org/10.21649/akemu.v31i4.5924Keywords:
Case Series, Transabdominal, Vesicovaginal Fistula, Obstetric and Gynecologic SurgeriesAbstract
Background: Vesicovaginal Fistula (VVF) may result from obstetric injuries or gynecologic surgeries, resulting in incontinence of urine, which needs surgical intervention to achieve the best results.
Objectives: To evaluate the clinical presentation, surgical results, and complications in patients diagnosed and treated for Vesicovaginal Fistula.
Methods: This was a descriptive, retrospective, single-center case series that evaluated 15 consecutive VVF patients treated at the Pakistan Kidney and Liver Institute & Research Center (PKLI&RC) in the time frame from September 2018 to September 2024 through transabdominal repair, depending on the size and site of the fistula. The data was collected pre-operatively, intra-operatively, and post-operatively.
Results: The mean age was 43.00 ± 7.51 years with a mean BMI of 28.36 ± 5.16 kg/m2. A total of 12 patients (80%) complained of urine leakage via the vagina. Eight patients (53.3%) had previous VVF repair, with abdominal hysterectomy being the main cause in 4 patients (26.7%). The median operating time was 215 minutes (IQR 180-270 minutes) with a median post-operative stay of 5 days (IQR 4-6 days). Blood transfusion was not required. The complications seen were transient fever and discomfort in 2 patients (13.3%) with long-term complications in 2 patients (13.3%).
Conclusion: Main causes of VVF include obstetric and gynecologic surgeries. Repair procedure, surgical method, results are good, and the complications are minimal. There are specific strategies that ought to be followed after the procedure to facilitate a successful recovery and to prevent a relapse.
References
1. Chinthakanan O, Sirisreetreerux P, Saraluck A. Vesicovaginal fistulas: prevalence, impact, and management challenges. Medicina (Kaunas). 2023; 59(11):1947. doi: 10.3390/medicina59111947.
2. Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: review and recent trends. Indian J Urol. 2019;35(4):250–8. doi: 10.4103/iju.IJU_147_19.
3. Malik MA, Sohail M, Malik MT, Khalid N, Akram A. Changing trends in the etiology and management of vesicovaginal fistula. Int J Urol. 2018; 25(1):25-9. doi: 10.1111/iju.13419.
4. Kurokawa I, Nomura Y, Nakagawa C, Okada Y, Fuji K, Yoshimura Y. Transvaginal vesicovaginal fistula closure: a retrospective study of 28 cases at a single facility in Japan. Int J Urol. 2023;30(7):586-91. doi: 10.1111/iju.15181.
5. Margulies SL, Geller EJ. Vaginal repair of vesicovaginal fistula: comparison of national practice patterns by surgeon specialty. Int Urogynecol J. 2022;33(6):1675-83. doi: 10.1007/s00192-022-05199-1.
6. Hernández-Hernández D, Navarro-Galmés MÁ, Padilla-Fernández B, Ramos-Gutiérrez VJ, Castro-Díaz DM. Same problem, different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair-case report. Transl Androl Urol. 2021;10(10):3885-3890. doi: 10.21037/tau-21-373.
7. El-Azab AS, Abolella HA, Farouk M. Update on vesicovaginal fistula: a systematic review. Arab J Urol. 2019;17(1):61-8. doi: 10.1080/2090598X.2019.1590033.
8. Jen RP, Rangel E, Sugano DE, Rodriguez LV. Vesicovaginal fistula: open approach. In: Sotelo R, Polotti CF, Arriaga J, editors. Urinary fistula. Cham: Springer; 2022. doi: 10.1007/978-3-031-15317-4_10.
9. Mengistu Z, Ayichew Z. Large vesicovaginal fistula after vaginal insertion of a plastic cap healed with two weeks of catheterization: a case report. Int Med Case Rep J. 2022; 15:437-41. doi: 10.2147/IMCRJ.S380716.
10. Jefferson FA, Hanson KT, Robinson MO, Habermann EB, Madsen AM, Gebhart JB, et al. Perioperative outcomes of vesicovaginal fistula repair by surgical approach. Urogynecology. 2024;30(2):114-22. doi: 10.1097/SPV.0000000000001394.
11. Özkaya F, Cinislioğlu AE, Aksoy Y, Adanur Ş, Topdağı Yılmaz EP, Polat Ö, et al. Vesicovaginal fistula repair experiences in a single center high volume of 33 years and necessity of cystostomy. Turk J Urol. 2021;47(1):66-72. doi: 10.5152/tud.2020.20080.
12. Goh J, Romanzi L, Elneil S, Haylen B, Chen G, Ghoniem G, et al. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn. 2020;39(8):2040-2071. doi: 10.1002/nau.24508.
13. Johnson BE, Venishetty N, Sung J, Goueli R. Case report: Development of vesicouterine and vesicovaginal fistulas after uterine rupture. Urol Case Rep. 2022;46:102297. doi:10.1016/j.eucr.2022.102297.
14. Niu S, Li Y, Tu S, Niu S, Qian J, Yang F, et al. Minimally invasive complete urinary tract drainage in the treatment of vesicovaginal fistula: a case report. Exp Ther Med. 2022;24(5):1-5. doi: 10.3892/etm.2022.11582.
15. Pandit H, Tajane A, Wagholika H, Shaikh A. Vesico vaginal fistula. In: Jain N, editor. Complex total laparoscopic hysterectomy (TLH) with newer approaches in bladder dissection. Singapore: Springer; 2024. doi: 10.1007/978-981-97-3226-5_23.
16. Nizamuddin, Elahi F, Ali M, Akbar F, Hussain M, Gul S. Outcome of vesicovaginal fistula repair at Urology Department STH Swat. J Saidu Med Coll Swat. 2020;10(2):132-4. doi:10.52206/jsmc.2020.10.2.%25p.
17. Hafeez M, Asif S, Hanif H. Profile and repair success of vesicovaginal fistula in Lahore. J Coll Physicians Surg Pak. 2005;15(3):142-4.
18. Ashraf A, Jafari G, Mahboob G, Subhani M, Munir M, Akmal H, et al. Vesicovaginal fistula, causative factors and outcome of surgical management: An experience at PMC/Allied Hospital Faisalabad. Ann Punjab Med Coll. 2012;6:150-5. doi: 10.29054/apmc/2012.448
19. Widyasari A, Setyohadi TH, Hardianto G, Kurniawati EM. Vesicovaginal fistula: Characteristics, diagnosis, and management at Dr. Soetomo Hospital in three years (2020-2022). J Obstet Gynecol Cancer Res. 2025;10(8):588-91. doi:10.24200/jogcr.10.8.588.
20. Deepak N, Deepak MK. Surgical management of vesicovaginal fistula (VVF): Experience from a tertiary care centre. Int J Acad Med Pharm. 2025;7(2):61-4. doi:10.47009/jamp.2025.7.2.13.
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