A fistula is defined as an abnormal connection between two neighboring organs. In female pelvic medicine, the most common fistula is a VVF, a vesico-vaginal fistula, a connection that develops between the vagina and bladder.
Though not overall common, it most commonly occurs after a hysterectomy.
Most women will notice small squirts or large gushes of urine leaking from their vagina, while laying down or with activity. It will become most apparent within days to weeks after the hysterectomy.
A very meticulous evaluation of the vagina, bladder, and entire urinary tract is necessary to determine the size, location, number of fistulae, and if other undiscovered injuries to the urinary tract exist.
VVFs can also occur after pelvic radiation or pelvic/vaginal surgery. A recto-vaginal fistula can occur after vaginal or rectal surgery, as well as after childbirth.
Stool leakage from the vagina will usually call attention to the presence of the RVF. Careful exam of the vagina, anus, and rectum, and sometimes pelvic imaging are necessary to determine the extent and location of the RVF.
A VVF or RVF will most often require surgical correction that must be planned once the tissue is healthy enough for surgery to maximize the best chance for healing.