Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF). VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. In addition to the medical sequelae from these fistulas, they often have a profound effect on the patient's emotional well-being. The incidence of VVF per 1,000 childbirths and the total number of new VVF cases per year are unknown. In Tanzania, it is assumed that per year 1,200 new cases of VVF occur.
What is the cause of VVF?
VVF is often caused during prolonged and obstructed child labour. The constant pressure of the fetal scull against the soft tissue around the vagina and the bladder and/or rectum cuts off the blood supply to the tissues, causing them to disintegrate. A hole is left then, and urine and/or faeces leak continuously and uncontrollably from the vagina. In nearly all cases of obstetric fistula, the baby dies. VVF can also result from violent rape. A small number of fistulae may also be caused by problems in surgery such as Caesarean section or hysterectomy, or as a result of mistakes in the practice of traditional circumcision.
What cures VVF?
VVF and RVF can be repaired surgically unless they are too large or associated damage to other tissues makes repair impossible. Treatment is only available in a few specialist hospitals and most women do not know it can be done or how to get it. Fistulae could often be prevented, and between 40% and 95% of small or new fistulae can be cured naturally by the insertion of an in-dwelling catheter to relieve pressure on the bladder during a period of 4 to 6 weeks after delivery.
For subsequent births, Caesarean section is always recommended to avoid re-opening of the fistula. Few rural women in poor countries have physical or financial access to obstetric facilities where Caesarean sections can be done, and it is likely that fistulae re-open during childbirth.
In 2006, CCBRT was able to perform 173 VVF surgeries. For the coming years, CCBRT is planning to increase the number of surgeries to 240 per year.
What prevents VVF?
Promotion of quality, accessible, obstetric care can be a major step towards reducing the incidence of VVF. VVF is not an isolated condition that can be solved by medical and surgical skills alone. Prevention and awareness of the problem are equally important.