What is a vesicovaginal fistula (VVF) and why does it happen?
A fistula is an abnormal passage between two organs. In VVF, urine passes from the bladder straight into the vagina, so you are wet day and night, even though you may still pass some urine normally. In India the common causes are:
- Obstructed labour: when labour is very long and the baby’s head presses on the bladder for hours, the tissue loses its blood supply and breaks down a few days later.
- Hysterectomy and other pelvic surgery, including caesarean section: a hidden injury to the bladder may show as leakage one to three weeks after the operation.
- Radiotherapy for cervical cancer: a fistula can appear months or even years later.
- Less often, cancer itself, injury or infection.
A similar leak can come from a ureter (the tube from kidney to bladder) opening into the vagina. This is treated differently, sometimes with a stent or ureteric reimplantation. A fistula is not your fault, and it can usually be repaired.
Who needs VVF repair, and when a catheter alone may be enough
Most fistulas need an operation. A small fistula noticed within days of surgery is sometimes treated first with a catheter that keeps the bladder empty for a few weeks, which lets some close on their own. If leakage continues, repair is planned.
Repair may be delayed when the tissue is swollen or infected, when anaemia or poor nutrition need correcting, or when cancer must first be ruled out after radiotherapy. Where tissues are badly damaged by radiation, other options such as diverting the urine are discussed. If leakage is with coughing or urgency rather than constant, the cause is more likely stress or urge incontinence.
Tests before VVF repair: dye test and cystoscopy
- Dye test: coloured fluid is put into the bladder through a catheter while gauze swabs sit in the vagina. A coloured swab confirms a bladder fistula. A wet swab that is not coloured suggests the leak comes from a ureter, and further tests are done.
- Cystoscopy: a thin telescope shows the number, size and position of the openings, and how close they are to the ureter openings. It is often combined with an examination under anaesthesia. Read about cystoscopy.
- CT urography or ultrasound to check the kidneys and ureters.
- Urine culture, blood count, sugar and kidney function.
- Biopsy of the fistula edge if it followed radiotherapy or cancer is suspected.
To prepare, infection is treated and anaemia corrected. Some women past menopause are given vaginal oestrogen cream for a few weeks to improve the tissue.
When is the right time to repair a VVF?
Timing depends on the cause and the state of the tissue, and practice varies between surgeons. A clean, simple fistula after hysterectomy may be repaired early, within the first few weeks. When the tissue is inflamed, waiting about six to twelve weeks lets it settle. Fistulas after obstructed labour are often repaired around three months after delivery, and fistulas after radiotherapy usually need a longer wait. The first repair is the most important, because each repeat operation works on more scarred tissue, so the date is set after examination, not in a hurry.
How VVF repair surgery is done: vaginal and abdominal routes
The operation is done under spinal or general anaesthesia. The fistula edges are freed, the bladder is closed in layers without tension, and the vaginal wall is closed separately so the stitch lines do not lie on top of each other. Thin tubes (ureteric catheters) may be placed to protect the ureters.
Vaginal route
Used for most low and mid fistulas. There is no cut on the tummy. A pad of fatty tissue from the labia (a Martius flap) may be placed between the layers to add blood supply. It usually takes one to two hours.
Abdominal route, open or laparoscopic
Used for fistulas high at the top of the vagina, large or complex fistulas, those near the ureters, or after a failed repair. The bladder is opened, the fistula removed, and the omentum (a fatty apron inside the tummy) is often placed between bladder and vagina. In suitable cases this is done laparoscopically through small keyhole cuts; see laparoscopic urology surgery. It takes about two to four hours.
Equipment and where it is done
Surgery is at ManglamPlus Medicity, Mansarovar, using a cystoscope, ureteric catheters, laparoscopic camera and instruments where needed, and fine dissolving stitches.
Hospital stay, catheter care and recovery after VVF repair
| Time | What usually happens |
|---|---|
| Day of surgery | A catheter drains the bladder continuously; a vaginal pack may stay for a day |
| Days 1-7 | Home after about two to four days (vaginal route) or four to seven days (abdominal route), with the catheter; drink plenty; medicines may be given for bladder spasms |
| Weeks 2-3 | Catheter removed, often after a dye study confirms healing |
| Up to 3 months | Pass urine every two to three hours at first; no intercourse, tampons or heavy lifting for about three months |
The catheter must never stop draining: keep the tube free of kinks and the bag below the bladder. Call +91 9649888222 at once if it stops draining, or if you have fever, heavy bleeding or leakage again.
Risks of VVF repair and what is done about them
- The fistula does not close or reopens: another repair is planned after the tissue heals, sometimes by a different route
- Infection and bleeding
- Injury to a ureter, reduced by placing ureteric catheters
- Bladder spasms while the catheter is in
- Leakage after closure: stress or urge leakage can remain, especially after obstetric fistula, and is treated separately
- Narrowing or shortening of the vagina, which can affect intercourse
- Blood clots and anaesthesia risks
The chances of a good repair are improved by the right timing, healthy tissue, tension-free layered closure, extra tissue between the layers, and a catheter that drains without a break.
Life after VVF repair: pregnancy, dignity and support
Constant leakage can bring smell, skin rashes and isolation, and many women stop going out or working. Until repair, use pads, change them often, wash with plain water, use a barrier cream and drink well so urine stays dilute. Talking to family or a counsellor helps; this is a medical problem, not a personal failing.
After a successful repair, a future pregnancy is possible. You are usually advised to wait several months and to plan the delivery with your obstetrician, who will often recommend a caesarean section to protect the repair. Pelvic floor exercises help once healing is complete. For other women’s bladder problems, see female urology treatment.
Cost of VVF repair surgery in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- The route of repair: vaginal, open abdominal or laparoscopic
- Tests such as cystoscopy, examination under anaesthesia and CT urography
- Whether ureteric catheters or extra tissue flaps are needed
- The number of nights at ManglamPlus Medicity and the room category you choose
- Catheter care and follow-up visits over two to three weeks
- Your insurance policy’s or scheme’s terms
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
VVF repair surgery with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Can a VVF heal without an operation?
A small fistula found soon after surgery sometimes closes with a catheter left in for a few weeks. Most fistulas, especially older or larger ones, need surgical repair.
How soon after a hysterectomy can the fistula be repaired?
A clean, simple fistula may be repaired within the first few weeks. If the tissue is swollen, waiting about six to twelve weeks is usual. The decision is made after examination and cystoscopy.
Will I need a cut on my tummy?
Many fistulas are repaired through the vagina without any tummy cut. High or complex fistulas may need the abdominal route, open or laparoscopic.
Can I go home with the catheter?
Yes. Most women go home with the catheter and come back for its removal after about two to three weeks. You will be shown how to care for it.
Can I have children after VVF repair?
Yes, many women can. Plan the pregnancy with your doctors; a caesarean delivery is usually advised to protect the repair.
What if the first repair does not work?
A further repair is usually possible after the tissue has healed, often after a few months, sometimes through a different route or with extra tissue support.
Is VVF repair covered under insurance or government schemes?
Cover depends on the hospital’s empanelment and your policy or scheme. Please confirm with the ManglamPlus Medicity billing desk. See payment, insurance and schemes.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.