RVF and VVF

VESICOVAGINAL FISTULA

• Is an abnormal communication between urinary

bladder and the vagina results in continous
involuntary discharge of urine into the vaginal
vault
 Etiology:
1. Ischemia – due to prolong compression of
bladder in obstructed labour
2. Trauma-instrumental delivery, abdominal
hysterectomy
3. gynaecological: malignancy, radiation, trauma,
infective diseases
 Risk factors
• Prior pelvic or vaginal delivery
• Previous pelvic inflammatoty disease
• Ischemia
• Diabetis
• Arterioscerosis
• Carcinoma
• infection
 Signs and symptoms
1. Constant urinary drainage per vagina
2. Recurrent cystitis, perineal skin irritation,
vaginal fungal infection, rarely pelvic pain
3. In large vvf, pt may not void at all
 diagnosis
 Speculum examination
 History
 Intravenous pylogram
 management
• Prevention:
 Adequate antenatal care
 Emtying bladder frequently before and after
delivery
 Avoid bladder injury
• Medical:
 Transurethral or supra pubic cathter is placed
 Infection control
 Surgical:
1. Fistula repair; transabdominal, transvaginal,
transvesical approach is used
2.Laparoscopic fistula repair
3. Electrocautery and endoscopic closure using
fibrin glue
4. Laser welding
 Post op care

 Bladder dainage using cathter

 Acidification of urine using vit c 500mg orally tid
 estrogen replacement therapy
 Antibiotic therapy:
 Administer stool softner
 fibre rich diet
 Avoid pelvic and speculum examinations during
1st few weeks
 Pelvic rest for 3 months: prohibit coitus , tampoon
use
RECTO VAGINAL
FISTULA
RVF
• RVF is a medical condition where there is a
fistula or abnormal connection between rectum
and vagina
• Etiology:
1. Congenital
2. Acquired- obstructed labour, instrumental
injury,trauma, malignancy of vagina, radiation,
diverticulitis, crohn s disease
 symptoms
• Passage of gas stool and pus from the vagina
• A foul smelling vaginal discharge
• Recurrent vaginal tract infection
• Recurrent UTI
• Irritation or pain on the vulva, vagina, anus
• Pain during sexual activity
• Urgent bowel movements
• Inability to control bowel movements
 diagnosis
• History
• Physical examination
• Vaginal and rectal examination
• Vaginogram
• barium enema
• anorectal ultrasound
• MRI, CT
 MANAGEMENT
• MEDICAL:
 Antibiotic therapy
 Drainage of abscess
 Dietary modification and suppementary fibre
 Perform biopsy for neoplasm, treat neoplasm
 surgical
 Perineal or trans abdominal appraoch for repair
 Transanal advancement flap repair
 Transvaginal inversion repair
 Bioprosthetic repair
 Simple fistulotomy
 Post op care
 Note vaginal discharge
 Bed rest
 Perineal cleaning atleast twice daily and after
each voiding and defecation
 Local application of ice pack for comfort
 Use of laxatives
Thank you