Summary about Disease
A urethrovaginal fistula (UVF) is an abnormal connection between the urethra and the vagina. This connection allows urine to leak uncontrollably from the urethra into the vagina, leading to urinary incontinence and related hygiene issues. The size of the fistula can vary, impacting the severity of symptoms. UVFs are relatively rare and can significantly impact a woman's quality of life.
Symptoms
The primary symptom of a urethrovaginal fistula is the involuntary leakage of urine from the vagina. Other symptoms may include:
Urinary incontinence (constant or intermittent)
Recurrent vaginal infections
Vaginal irritation or discharge
Pain during intercourse (dyspareunia)
Odor
Feelings of wetness or discomfort in the vaginal area
Causes
Urethrovaginal fistulas are most often caused by:
Surgical Complications: This is the most common cause, often resulting from surgeries such as anterior vaginal repair, anti-incontinence procedures (slings), or other pelvic surgeries.
Trauma: Injuries to the pelvic area from accidents or childbirth can rarely result in UVFs.
Radiation Therapy: Radiation treatment to the pelvic area for cancer can damage tissues and lead to fistula formation.
Infection: Rarely, severe infections or abscesses in the pelvic area can erode through tissue and create a fistula.
Chronic inflammation: In very rare situations, long-standing inflammatory processes such as Crohn's disease could lead to fistula formation.
Advanced cancer: Rarely, advanced pelvic cancers can invade tissues and create abnormal connections.
Medicine Used
There are no medications that can directly heal a urethrovaginal fistula. Treatment is primarily surgical. However, medications may be used to manage associated symptoms:
Antibiotics: To treat or prevent vaginal infections.
Estrogen Cream: Can help improve vaginal tissue health, particularly in postmenopausal women, to aid in healing after surgery.
Is Communicable
No, a urethrovaginal fistula is not a communicable or contagious disease. It cannot be spread from person to person.
Precautions
There are limited precautions to prevent UVFs, as they often arise from surgical complications. However, the following can be considered:
Choosing an experienced surgeon: If undergoing pelvic surgery, select a surgeon with experience in the specific procedure to minimize the risk of complications.
Careful surgical technique: During surgery, meticulous attention to tissue handling and closure is crucial.
Prompt treatment of infections: Treat vaginal or pelvic infections promptly to prevent potential complications.
Adequate post-operative care: Follow all post-operative instructions carefully to promote healing and prevent complications.
How long does an outbreak last?
A urethrovaginal fistula is not an "outbreak" situation. It's a continuous condition until surgically repaired. The leakage and symptoms will persist until the fistula is closed.
How is it diagnosed?
Diagnosis typically involves:
Pelvic Exam: A physical examination to visualize the vaginal area and identify any abnormalities.
Methylene Blue Test: A dye (methylene blue) is instilled into the bladder. If the dye is seen in the vagina, it confirms the presence of a fistula.
Cystoscopy: A thin, flexible tube with a camera (cystoscope) is inserted into the urethra to visualize the bladder and urethra.
Vaginoscopy: Similar to a cystoscopy, but the scope is inserted into the vagina to visualize the vaginal walls.
Imaging Studies: In some cases, imaging such as MRI or CT scan may be used to further evaluate the fistula and surrounding tissues.
Fistula Probe: A small probe may be gently inserted into the suspected fistula to determine its tract and size.
Timeline of Symptoms
The onset of symptoms depends on the cause:
Post-Surgical: Symptoms usually appear within days or weeks after the surgery that caused the fistula.
Trauma: Symptoms would be immediate or shortly after the injury.
Radiation Therapy: Symptoms may develop months or even years after radiation treatment. The primary symptom (urinary leakage) is usually the first to be noticed.
Important Considerations
Impact on Quality of Life: UVFs can significantly impact a woman's physical, emotional, and social well-being.
Surgical Repair: Surgical repair is the mainstay of treatment. The specific surgical approach depends on the size, location, and cause of the fistula.
Psychological Support: Counseling or therapy may be beneficial to address the emotional distress associated with this condition.
Recurrence: There is a risk of recurrence after surgical repair, although this can be minimized with proper surgical technique and post-operative care.
Specialist Referral: It's important to be seen by a urologist or urogynecologist experienced in fistula repair.