ABSTRACT
In developed countries, vesicovaginal fistula (VVF) is often a complication of urogynecologic surgery. Abdominal hysterectomy is the most common cause of VVF, estimated to occur in one in 1800 procedures.1
Radiation therapy and obstetric traumas are other known causes of VVF. The actual cause of fistula formation postoperatively is not clearly understood, but is usually related to bladder injury. The diagnosis is often made 1-3 weeks postoperatively with the most common presentation being persistent vaginal leakage. Other symptoms include hematuria, fever, vaginal or suprapubic pain, and a history of recurrent cystitis. The diagnosis is confirmed with some form of oral (pyridium) and/or intravesical dye (methylene blue) resulting in vaginal tampon discoloration. The combination of oral and intravesical dye can be used to differentiate vesicovaginal from ureterovaginal fistula or identify the coexistence of these fistulas. Axial imaging with intravenous contrast or an intravenous pyelogram should be used to further assess the possibility of a concomitant ureterovaginal fistula. Cystoscopy and further diagnostic testing may be required to localize the fistula and rule out ureterovaginal fistula.
