Why it happens
In India the two commonest causes are injury during hysterectomy or caesarean section, and prolonged obstructed labour. Pelvic radiotherapy and advanced pelvic cancer account for a smaller number. Whatever the cause, this is a mechanical problem with a mechanical solution — not something to live with.
Assessment
Diagnosis is confirmed with examination, a dye test, cystoscopy and imaging to define the size and position of the fistula and to check the ureters are not involved. Timing matters: a small, clean fistula found very early may be managed with catheter drainage, while most need surgery once local inflammation has settled.
The repair
Depending on the site and size, repair is done through the vagina or the abdomen, and an interposition flap of healthy tissue is often placed between the closed layers to keep them separate while they heal. Continuous catheter drainage for two to three weeks afterwards is essential to success — this is the part patients find tedious and the part that most determines the result.
Success rates for a first, well-planned repair are high. Repeat repairs are harder, which is a strong argument for having the first attempt done by someone who does this work regularly.
Vesicovaginal Fistula Repair — common questions
Will the leakage stop completely after surgery?
In most patients, yes, after a successful first repair. Some women have residual urgency for a while, which is treated separately.
How soon after the injury can repair be done?
Usually after six to twelve weeks, once tissue inflammation settles. Very small, early fistulas are occasionally managed with catheter drainage alone.
Is the surgery done through the abdomen or vagina?
Both routes are used. Position and size of the fistula, and previous repairs, decide which gives the better chance of a lasting closure.
Can I have children afterwards?
Often yes, with planned obstetric care. A caesarean delivery is usually advised to protect the repair.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains vesicovaginal fistula repair in general terms; your own treatment plan depends on your reports and examination.