A vesicovaginal fistula (VVF) is an abnormal connection between the bladder and vagina that allows urine to leak continuously or repeatedly through the vagina. After hysterectomy or pelvic surgery, leakage may start days to weeks later. A woman may still pass urine normally through the urethra while also leaking vaginally. Diagnosis uses examination, dye testing and cystoscopy; CT urography may be needed to exclude an associated ureteric injury. Small fresh fistulas occasionally close with bladder drainage, but many established fistulas need surgical repair once infection, inflammation and tissue condition have been optimised.

Common symptoms

• Continuous watery leakage from the vagina.
• Wetness both day and night unrelated to coughing or urgency.
• Normal urethral urination may still occur.
• Vaginal irritation, odour or recurrent UTI.
• Symptoms beginning after hysterectomy, Caesarean section, pelvic surgery, radiation or cancer treatment.

How is VVF different from ordinary incontinence?

What causes VVF?

• Gynecological or pelvic surgery, especially hysterectomy.
• Obstetric injury after prolonged obstructed labour.
• Pelvic radiotherapy.
• Pelvic malignancy or cancer surgery.
• Severe pelvic trauma or infection, less commonly.

How is it diagnosed?

• Pelvic/speculum examination.
• Bladder dye test to demonstrate a bladder-to-vagina leak.
• Cystoscopy to inspect the bladder opening and ureteric orifices.
• CT urography with delayed images when ureteric injury is possible.
• Urine culture and renal-function tests when infection or upper-tract involvement is suspected.

Can a VVF heal with a catheter alone?

A small recently formed fistula without radiation or major tissue loss may occasionally close with continuous bladder drainage. The probability is lower for large, mature, radiated or recurrent fistulas. Unsuccessful drainage should not indefinitely delay definitive planning.

Surgical repair

Repair may be performed through the vagina, abdomen, laparoscopy or robotically. Route is selected according to location, size, access, previous repairs, ureteric involvement, radiation and surgeon expertise. Core principles are healthy tissue, tension-free watertight closure and reliable bladder drainage.

When is repair performed?

There is no single mandatory waiting period for every patient. Early repair may be reasonable in selected clean postoperative fistulas, while inflamed, infected, ischemic or radiated tissues may need time for optimisation.

How the leakage pattern guides diagnosis

A vesicovaginal fistula creates an abnormal connection between bladder and vagina. Many women still pass urine normally because the urethra remains intact; the clue is continuous or near-continuous wetness between normal voids. This differs from stress incontinence, which occurs with cough/exertion, and urgency incontinence, which is preceded by a compelling need to void.

Examination and dye testing can confirm bladder-to-vagina leakage. Cystoscopy identifies the fistula’s relation to the ureteric orifices and bladder neck. When dye testing is negative or ureteric injury is possible, CT urography with delayed excretory images is particularly useful because a ureterovaginal fistula may cause continuous leakage while the bladder itself remains intact.

Small, fresh postoperative fistulae occasionally close with continuous catheter drainage, but spontaneous closure is not reliable. Surgical route is chosen from fistula location, size, tissue quality, prior repair, radiation and surgeon expertise rather than from a rule that all VVF must be repaired vaginally or abdominally. The goal is a tension-free, watertight closure in healthy tissue with dependable bladder drainage during healing.

When should a VVF be repaired?

Repair timing is individual. A tiny fresh postoperative fistula recognised early may be given continuous catheter drainage in the hope of spontaneous closure. If the fistula persists, surgery is planned when tissues are healthy enough to hold sutures and infection or inflammation has been controlled.

The old rule that every fistula must wait three months is too rigid. Evidence does not show a clear universal advantage of early versus delayed repair, and current EAU guidance recommends tailoring timing to tissue condition and surgeon requirements. Radiation-associated fistulae, active necrosis and severe inflammation generally need more cautious timing.

During the waiting period, skin protection matters. Continuous urine can cause painful dermatitis, odour and social isolation. Absorbent pads, barrier creams, treatment of infection and psychological support are legitimate parts of fistula care rather than minor comfort measures.

How VVF is mapped before choosing a repair

The surgeon needs to know fistula size, number, exact distance from the ureteric openings and bladder neck, tissue quality, previous repairs and whether radiation or malignancy is involved. Vaginal examination and cystoscopy often provide the most useful anatomical information. A dye test can confirm bladder-to-vagina leakage, while upper-tract imaging is added when ureteric injury is possible.

This mapping prevents two common mistakes: repairing a bladder fistula while missing a ureterovaginal fistula, and choosing an approach that cannot safely access a complex high or peri-ureteric defect. In recurrent disease, the scarred tissue from previous surgery is part of the map.

The route—vaginal, abdominal, laparoscopic or robotic—is therefore a means of reaching the fistula safely. Current evidence does not show that one route is universally superior; surgeon experience and fistula anatomy are more important than choosing the newest platform.

What recovery means beyond closing the leak

Successful closure usually transforms daily life, but recovery can still include urgency, frequency or stress leakage from a separate bladder or sphincter problem. These symptoms should be reassessed after the fistula has healed rather than assumed to mean the repair failed.

Vaginal tissues also need time to heal. Intercourse is delayed according to the surgeon’s examination and protocol, particularly after a vaginal repair or tissue interposition. Persistent pain, bleeding or recurrent watery leakage should be reviewed.

For women who have lived with continuous leakage for months, skin irritation, social withdrawal and anxiety can be substantial. Restoring continence is the central goal, but pelvic-floor rehabilitation, skin care and psychological support can also be meaningful parts of recovery.

What to bring for consultation

• Operative and discharge records from the hysterectomy, Caesarean section or pelvic surgery.
• CT urography, ultrasound or MRI images/reports if already performed.
• Cystoscopy, dye-test or ureteric stent records if available.
• Serum creatinine, urine routine and culture.
• A simple description of when leakage started and whether normal urination still occurs.
• Details of fever, pelvic pain, drain output, wound leakage or previous repair attempts.

FAQs

Related reading

• Vesicovaginal Fistula Repair Explained
• Ureterovaginal Fistula After Hysterectomy
• Urinary Fistula After Gynecological Surgery
• Urinary Leakage After Hysterectomy: Could It Be a Urinary Fistula?
• Urethrocutaneous Fistula: Causes and Treatment
• Urologist in Latur

References

• European Association of Urology. EAU Guidelines on Non-neurogenic Female LUTS: Urinary Fistula, 2026 https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management
• European Association of Urology. EAU Guidelines on Urological Trauma, 2026 https://uroweb.org/guidelines/urological-trauma
• Thompson JC, et al. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol. 2024;143:229-241. PMID: 38033311 https://pubmed.ncbi.nlm.nih.gov/38033311/