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Vesicovaginal Fistula (VVF) Treatment in Gomti Nagar Extension, Lucknow – Swastik Urology Clinic
Swastik Urology Clinic provides specialised evaluation and definitive repair of vesicovaginal fistula (VVF) — an abnormal connection between the bladder and vagina resulting in continuous urinary leakage. Under the care of Dr. Aditya Sengar (Urologist), we offer thorough diagnostic assessment, short-term conservative management where appropriate, and meticulous surgical repair using transvaginal, transabdominal or minimally invasive approaches with tissue interposition to achieve durable closure and restore quality of life.
What is Vesicovaginal Fistula (VVF)?
A vesicovaginal fistula is a pathological opening between the bladder and vagina that permits continuous
leakage of urine from the vagina. Patients typically present with painless or bothersome continuous wetness,
malodour, skin irritation and social distress. Early evaluation and tailored management are essential for
successful outcomes.
Common Causes of VVF
Obstetric injury from prolonged obstructed labour, iatrogenic injury during pelvic surgery
(hysterectomy), pelvic radiation, pelvic malignancy, infection or severe pelvic trauma are the
most frequent causes worldwide. The cause influences tissue quality and repair strategy.
Clinical Presentation
Continuous leakage of urine per vaginam is the hallmark. Additional features include perineal
irritation, recurrent urinary infections, vaginal discharge, and emotional and social impact.
Diagnostic Evaluation
Evaluation includes detailed history and pelvic examination, dye tests (methylene blue), urine culture,
cystoscopy to localise the fistula, pelvic ultrasound and contrast studies (cystogram/CT urography)
when necessary. Assessment of fistula size, location, tissue quality and associated ureteric involvement
guides surgical planning.
Impact on Quality of Life
Continuous urinary leakage causes physical discomfort, skin breakdown, recurrent infections and significant
psychosocial distress. Definitive repair restores continence, dignity and social functioning.
Management Principles for Vesicovaginal Fistula
Management is individualised based on fistula aetiology, size, location and tissue condition:
1. Conservative Management – Small, early fistulas (often obstetric) may close with continuous bladder drainage using an indwelling or suprapubic catheter for 4–6 weeks while infection and inflammation are controlled.
2. Definitive Surgical Repair – Most fistulas require surgery. Choice of transvaginal vs transabdominal (open, laparoscopic or robotic) approach depends on fistula position, scar tissue, prior radiation and ureteric involvement. Multilayered, tension-free closure with robust tissue interposition is fundamental to success.
3. Tissue Interposition – Use of well-vascularised tissue (Martius labial fat pad, omental flap, peritoneal flap or gracilis muscle) between bladder and vagina reduces recurrence, especially in radiated or recurrent fistulas.
4. Address Associated Problems – Reimplantation of ureters, management of vaginal stenosis, correction of pelvic organ prolapse and treatment of infection or malignancy when present.
1. Conservative Management – Small, early fistulas (often obstetric) may close with continuous bladder drainage using an indwelling or suprapubic catheter for 4–6 weeks while infection and inflammation are controlled.
2. Definitive Surgical Repair – Most fistulas require surgery. Choice of transvaginal vs transabdominal (open, laparoscopic or robotic) approach depends on fistula position, scar tissue, prior radiation and ureteric involvement. Multilayered, tension-free closure with robust tissue interposition is fundamental to success.
3. Tissue Interposition – Use of well-vascularised tissue (Martius labial fat pad, omental flap, peritoneal flap or gracilis muscle) between bladder and vagina reduces recurrence, especially in radiated or recurrent fistulas.
4. Address Associated Problems – Reimplantation of ureters, management of vaginal stenosis, correction of pelvic organ prolapse and treatment of infection or malignancy when present.
Surgical Options for VVF Repair
1. Transvaginal Repair
• Preferred for low and mid-vaginal fistulas when tissue planes are accessible.
• Advantages: shorter hospital stay, less morbidity and direct access to fistula for multilayer closure.
2. Transabdominal Repair (Open/Laparoscopic/Robotic)
• Indicated for high, complex, recurrent or ureteric-involving fistulas.
• Allows ureteric reimplantation and good interposition (omental) options.
3. Interposition Flaps
• Martius labial fat pad for primary vaginal repairs.
• Omental or peritoneal flaps for abdominal approach and radiated fields.
4. Staged & Reconstructive Strategies
• Complex, radiated or recurrent fistulas may require staged procedures, vaginal reconstruction or urinary diversion in select situations.
Postoperative bladder drainage, infection control and follow-up cystography prior to catheter removal are standard to ensure healing.
• Preferred for low and mid-vaginal fistulas when tissue planes are accessible.
• Advantages: shorter hospital stay, less morbidity and direct access to fistula for multilayer closure.
2. Transabdominal Repair (Open/Laparoscopic/Robotic)
• Indicated for high, complex, recurrent or ureteric-involving fistulas.
• Allows ureteric reimplantation and good interposition (omental) options.
3. Interposition Flaps
• Martius labial fat pad for primary vaginal repairs.
• Omental or peritoneal flaps for abdominal approach and radiated fields.
4. Staged & Reconstructive Strategies
• Complex, radiated or recurrent fistulas may require staged procedures, vaginal reconstruction or urinary diversion in select situations.
Postoperative bladder drainage, infection control and follow-up cystography prior to catheter removal are standard to ensure healing.
Why Choose Swastik Urology Clinic for VVF Repair?
Swastik Urology Clinic offers compassionate, evidence-based care for women with fistula:
• Multidisciplinary Expertise
Coordination with gynaecology, plastic/reconstructive and colorectal teams for complex cases.
• Experience in Vaginal & Abdominal Approaches
Tailored approach using minimally invasive and open techniques with emphasis on tissue interposition and functional restoration.
• Preoperative Optimisation
Correction of infection, nutritional support and management of comorbidities to improve healing.
• Postoperative Support & Rehabilitation
Catheter management, wound care, pelvic floor rehabilitation and psychosocial support.
• Multidisciplinary Expertise
Coordination with gynaecology, plastic/reconstructive and colorectal teams for complex cases.
• Experience in Vaginal & Abdominal Approaches
Tailored approach using minimally invasive and open techniques with emphasis on tissue interposition and functional restoration.
• Preoperative Optimisation
Correction of infection, nutritional support and management of comorbidities to improve healing.
• Postoperative Support & Rehabilitation
Catheter management, wound care, pelvic floor rehabilitation and psychosocial support.
When should a VVF be repaired surgically?
Most VVFs require definitive surgical repair after allowing inflammation to settle and infection to resolve. Small, fresh obstetric fistulas may be trialled with catheter drainage for a few weeks; persistent fistulas or those due to surgery, radiation or large defects are best repaired surgically by an experienced team.
What is the success rate of VVF repair?
Success rates for primary transvaginal repair are high (often >85–95%) in non-radiated, well-vascularised tissue. Complex, recurrent or radiated fistulas have lower primary success and may need staged or adjunctive reconstructive measures.
How long is recovery after VVF repair?
Hospital stay varies with approach; many transvaginal repairs have short stays (2–5 days). Continuous bladder drainage is maintained for 10–21 days depending on repair, and sexual activity is deferred for 6–12 weeks. Full recovery includes wound healing, continence and addressing any associated pelvic issues.
What complications can occur after repair?
Possible complications include recurrence of fistula, urinary tract infection, bladder or vaginal scarring, ureteric injury (rare) and wound issues. Use of healthy interposition flaps and meticulous technique reduces complications.