A fistula is a hole between the vagina and usually the bladder. This hole leads to continuous leakage of urine from the bladder into the vagina and urinary incontinence.
The most common cause of this problem is gynecologic surgery. The bladder lies directly above the vagina and surgery on the vagina can lead to fistula. The types of surgery that can lead to this problem are:
Another cause of fistula is radiation therapy for gynecologic cancer. Radiation causes progressive damage and these fistula can occur many years after the treatment has been administered. In other countries, one of the most common causes of these fistulae is prolonged labor during childbirth. This cause is very rare in the United States because of modern obstetrics care.
Sometimes placing a catheter in the bladder can solve the problem and allow a fistula to heal. This is especially true just after some type of surgical injury. When fistula do not heal on their own they need to be closed surgically.
It is important to allow adequate time for inflammation to resolve before surgery is performed. This waiting period can be difficult for patients, but is essential to a successful surgical repair. Small fistula can be treated with a vaginal surgery, which is minimally invasive. Larger fistula need extensive reconstruction and often are closed from both the vagina as well as the abdomen.
In some cases, especially when radiation causes the fistula, the bladder cannot be saved, and patients need some type of urinary diversion to divert the urine from the bladder and create a new bladder made of bowel.
Simple closure of fistula from the vagina is a minimally invasive way of treating small fistula. Recovery from this surgery is quick. Patients have a catheter for two to three weeks to allow healing of the bladder, but the vaginal incision does not cause much pain. Patients are typically in the hospital overnight.
More extensive surgery involving opening the bladder from the abdomen takes considerably more time to recover from. Patients may be in the hospital for several days from this type of surgery.