Common causes of vesio-vaginal fistula
A. Trauma to instrumental delivery B. Ischemia and pressure neurosis of anterior vaginal wall & posterior bladder wall C.Caesarean section D. All of the above
Correct Answer: D. All of the above
Explanation
Common causes of vesicovaginal fistula (VVF) include conditions that damage the tissue between the bladder and vagina. The most frequent causes are:
1. Obstetric Causes (Most common in developing countries)
- Prolonged obstructed labor → Ischemic necrosis of vaginal and bladder walls.
- Use of forceps or instrumental delivery causing trauma.
- Cesarean section complications if bladder is accidentally injured.
2. Gynecological Surgical Causes (Most common in developed countries)
- Hysterectomy (most common surgical cause) – accidental injury to the bladder during removal of the uterus.
- Pelvic surgeries such as operations on ovaries or cervix.
3. Radiation Therapy
- Pelvic irradiation for cancers (e.g., cervical cancer) can cause tissue necrosis and delayed fistula formation.
4. Malignancy
- Cervical cancer, vaginal cancer, bladder cancer, or pelvic metastasis invading the bladder-vaginal wall.
5. Trauma
- Pelvic fractures
- Sexual assault
- Foreign body insertion
6. Infections
- Severe pelvic infections or necrotizing infections that erode into the bladder and vagina.
7. Iatrogenic Causes
- Unrecognized bladder injury during:
- Catheterization
- Endoscopic procedures
- Pelvic laparoscopic surgeries
Other Options Details
Here is the explanation of all the options related to causes of vesicovaginal fistula (VVF):
A. Trauma to instrumental delivery
Instrumental deliveries such as forceps or vacuum extraction can sometimes cause direct injury to the bladder or vaginal walls.
- Improper use
- Prolonged or difficult extraction
This trauma can create an abnormal connection between the bladder and the vagina, leading to a fistula.
B. Ischemia and pressure necrosis of anterior vaginal wall & posterior bladder wall
This is the most common cause, especially in obstructed labor.
When labor is prolonged, the fetal head presses the vaginal wall and bladder wall against the pelvis for many hours.
This pressure reduces blood flow (ischemia) → tissues die (necrosis) → a hole forms between the bladder and vagina → vesicovaginal fistula.
C. Caesarean section
A fistula can occur as a complication of a C-section when:
- The bladder is accidentally injured during surgery.
- There is postoperative infection or poor healing.
- Scar breakdown leads to a communication between bladder and vagina.
Although less common compared to obstructed labor, C-section–related VVF is increasingly reported.
D. All of the above
This option indicates that each of the above causes (A, B, and C) can lead to vesicovaginal fistula.
Thus, all listed conditions are recognized causes of VVF.
I hope that you liked this article.
Thanks!! 🙏 😊
Writer: Vandita Singh, Lucknow (GS India Nursing Group