Vesico-vaginal fistula

Vesico-vaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina.

The overall incidence of vesicovaginal fistula is unknown but was reported to be 2.11 per 100 births in Nigeria 1.

The tract is lined by squamous epithelium at the vaginal end and transitional epithelium at the bladder end, often with focal ulcerations and fibrosis.

Aetiology

There are a number of causes including

Other risk factors include trauma, pelvic inflammatory disease and diabetes 3.

Cystogram

A fluoroscopic cystogram is a commonly-used method for evaluating this type of fistula. Contrast is injected into the bladder through a Foley catheter and the fistulous tract is outlined. A number of oblique and lateral projections are needed to determine the location.

Air-fluid levels are seen within the vagina which disappear with 3-4 micturitions whereas air bubbles are seen within the bladder up to a week.

CT

The fistula may be seen as a hypodense area with excretion of contrast into the vagina on delayed CECT images. The tract may be visible if a CT cystogram is performed.

MRI
  • T1: tract is centrally hypointense (fluid)
  • T2: tract is hyperintense with air bubbles seen as low signal intensities
  • T1 C+ (Gd): peripheral enhancement on contrast
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Article information

rID: 20942
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Vesicovaginal fistula
  • Vesico-vaginal fistulation
  • Vesicovaginal fistulas
  • Vesicovaginal fistulae
  • Vesico-vaginal fistulae
  • Vesico-vaginal fistulas

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