OVERVIEW

Vesicovaginal (VVF) is an abnormal communication between the bladder and the vagina, this occurs due to complications of prolonged obstructed labor, hysterectomy or radiation in the pelvis due to cervical cancer and represents a significant deterioration in the quality of life of women who suffer from it.

The indications to repair a VVF are:

  • VVF that is not relieved by placing a bladder catheter
  • VVF that causes persistent urinary leak or repetitive urinary tract infections
  • Recurrence of a VVF after primary repair by vaginal or abdominal route
  • VVF that produces dyspareunia (vaginal pain when having sex)

Benefits of repairing a VVF

To repair a VVF, the communication between the vagina and the bladder must be closed, with which the urinary and sexual functions return to normal, improving the quality of life of the patient.

When performed by laparoscopy, repair of the VVF is a surgery that offers rapid recovery and little postoperative pain.

Risks and complications

The possible complications that may occur when performing the laparoscopic repair of a VVF are the same that can occur in any surgical procedure and these are: hemorrhage, damage to nearby organs, reactions to anesthesia, etc. However, these complications occur infrequently and can be resolved mostly during the same surgery.

The risk of conversion to open surgery is low (<5%), this may be due to difficulty in dissection or hemorrhage and is done to maintain patient safety.

Alternatives to VVF repair

The treatment options to repair a VVF are:

  • Open abdominal surgery
  • Vaginal surgery (when the fistula is near the vaginal introitus)
  • Endoscopic cauterization of the bladder (in fistulas smaller than 0.5 cm)

What to expect from VVF repair?

Day of surgery:

The day of the operation will arrive in the morning to the hospital in fasting

The surgery takes approximately 2 – 3 hours, however, this time is variable.

Anesthesia for this procedure is general, so you will be unconscious during surgery.

The pain after the VVF repair is minimal and can be effectively controlled with intravenous analgesics.

Food: on the day of surgery you can eat in the afternoon, there are no food restrictions, however, a balanced diet is recommended.

Physical activity: the same day of surgery you can walk in the afternoon. It is expected to feel a bit fatigued after any surgery, this problem resolves spontaneously within a few weeks after the VVF repair.

Hospital stay: most of the patients who underwent VVF repair remain hospitalized for 2 to 3 days.

Wounds: laparoscopic VVF repair requires 3 small incisions in the abdomen (each 1 cm or less), once they heal completely, these scars can rarely be seen.

Bladder catheter: After the surgery, a catheter is inserted, this prevents overdistention of the bladder and facilitates the healing of it; after 20-30 days, this catheter is removed in the urologist office.