Vesico vaginal fistula is an abnormal opening between the vagina and the bladder leading to continuous leakage of urine from the bladder into the vagina resulting in a condition called urinary incontinence.
The female reproductive tract and the urinary tract though situated within the pelvis and both have their openings in the external genitals do not have any form of opening linking them to each other. Nevertheless an abnormal situation can arise where there is passage connecting the bladder to the vagina leading to continuous leakage of urine into the vagina. This condition is referred to as vesico vaginal fistula.
VVF is a cause for concern in developing countries especially countries where there is poor obstetric care and where girl marriage is being practiced. This condition does not only affect the woman physically but psychologically and socially due to the urinary incontinence and the offensive odor.
Data has revealed that Nigeria has the highest prevalence rate of VVF worldwide. According to the United Nations Fund for Population Activities (UNFPA), about 800,000 women suffer from Vesico Vaginal Fistula (VVF) annually in Nigeria with the North accounting for over 85% of this figure.
FACTORS CONTRIBUTING TO THE DEVELOPMENT OF VVF
Factors that contribute to the high prevalence in developing countries include:
- Early marriage and childbearing
- Low literacy rate
- Poor or non attendance of antenatal
- Low social status for women
- Poor nutritional status
- Inadequate medical infrastructures
- Lack of access to emergency obstetric services.
CAUSES OF VVF
The specific causes of VVF include:
- Prolonged obstructed labor at childbirth.
- Complicated gynecological surgeries e.g hysterectomy
- Radiation therapy for gynecological cancer.
- Gynecological cancers
- Instrumentation of the vagina and urethra.
- Sexual violence.
SIGNS AND SYMPTOMS OF VVF
One convincing sign of VVF is leaking of urine from the vagina but the size of the fistula will also determine the sign. For a small fistula, there will be watery discharge from the vagina with the woman urinating normally but for a larger fistula, there is leaking of urine from the vagina continually. This is usually experienced after a recent pelvic operation or difficult labor although fistula caused by radiation takes longer time even up to 20 years after the radiation to show up.
The diagnosis of VVF is directed towards ascertaining the presence, the location, the size and the number of the fistula.
To confirm the presence of a fistula, the bladder is filled with a dilute solution of methylene blue and the patient made to stand, if there is fistula, a tampon or sterile pad inserted into the vaginal will be stained by the dye.
Cystoscopy is used to determine the location, size and the number. During cystoscopy, a thin tube with a camera and light on the end is inserted through the urethra and into the bladder so that the inside of the bladder can be visualized on a monitor.
Some fistulas will close on their own within weeks and this process is enhanced by inserting a catheter into the bladder to drain the urine. One important factor here is the nutritional status of the patient. When fistulas don’t close up intentionally, a surgical repair will be required. Surgical repair for VVF can be done in two ways either through the vaginal or the abdomen.
The vaginal route is very effective for smaller fistula with less complications and shorter recovery time.
The abdominal approach to VVF repair although with increased complications is recommended in complex fistulas or when vaginal approach is contraindicated. It also has a higher success rate and less failure.
When surgical repairs fail repeatedly either due to the fact that the fistula is caused by radiation or because there is co- existing morbidity like cancer, urinary diversion is the best option.
– Vesico-Vaginal Fistula. https://healthcare.utah.edu/urology/conditions/vesico-vaginal-fistula.php#tabs-accordion1
– Confirmed: Nigeria has the highest prevalence rate of vesico vaginal fistula(VVF) in the world by Duru Ebube March 4, 2016. https://oblongmedia.net/2016/03/04/confirmed-nigeria-has-the-highest-prevalence-rate-of-vesico-vaginal-fistula-vvf-in-the-world/
– Vesico vaginal fistula (VVF): a shift in epidemiolody in northeastern Nigeria..A Kullima, B.M Audu, M Bukar, M.B Kawuwa, A.G Mairiga, B Bakohttp://dx.doi.org/10.4314/ebomed.v8i1.52633
– 800,000 women affected by VVF annually in Nigeria — UN August 8, 2015 Premium Times. http://www.premiumtimesng.com/news/more-news/188055-800000-women-affected-by-vvf-annually-in-nigeria-un.html
– Vesicovaginal Fistula: Diagnosis and Management Michael Stamatakos , Constantina Sargedi, Theodora Stasinou , and Konstantinos Kontzoglou. 2014 Apr; 76(2): 131–136. Published online 2012 Dec 14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039689/.