Laparoscopic Vesicovaginal Fistula (VVF) Repair
PACE Hospitals
Understanding Vesicovaginal Fistula (VVF)
A Vesicovaginal Fistula is an abnormal opening between the urinary bladder and the vagina, which causes continuous urine leakage through the vagina. It is one of the most distressing urological and gynecological complications a woman can experience, often affecting physical comfort, emotional health, and social well-being.
VVF commonly develops after gynecological surgeries, difficult childbirth, pelvic trauma, or radiation therapy. While it causes no immediate life-threatening condition, it has a profound impact on quality of life — leading to embarrassment, isolation, and psychological distress.
At PACE Hospitals, Hyderabad, our expert
urologists and gynecologic surgeons use advanced laparoscopic and minimally invasive techniques to repair vesicovaginal fistulas with high success rates and minimal scarring, helping women regain control, confidence, and comfort.
Causes of Vesicovaginal Fistula
VVF can arise from a range of surgical, obstetric, or traumatic causes.
Common Causes Include:
- Post-surgical complication — particularly after hysterectomy (uterus removal surgery)
- Prolonged obstructed labor or instrumental vaginal delivery
- Radiation therapy for pelvic cancers (cervical, bladder, or endometrial cancer)
- Pelvic trauma or accident involving the urinary tract
- Infections or inflammatory diseases of the pelvis
- Malignancy (cancer invading the bladder or vagina)
Among these, hysterectomy-related fistulas are the most common in developed and urban healthcare settings, while obstetric fistulas still occur in rural regions due to inadequate maternal care.
Symptoms of Vesicovaginal Fistula
Symptoms usually appear a few days or weeks after surgery or delivery. The most characteristic sign is continuous leakage of urine through the vagina, even when the patient attempts to urinate normally.
Typical Symptoms Include:
- Constant urinary leakage from the vagina
- Foul-smelling vaginal discharge
- Recurrent urinary tract infections (UTIs)
- Irritation and soreness in the vaginal area
- Pelvic or lower abdominal pain (in certain cases)
- Emotional distress and social embarrassment
If not treated promptly, the condition can lead to skin infections, depression, marital strain, and chronic bladder irritation.
Diagnosis of Vesicovaginal Fistula
Early and accurate diagnosis is important to successful treatment.
Diagnostic Evaluation at PACE Hospitals Includes:
- Clinical Examination: Pelvic examination to assess the site, size, and number of fistulas.
- Dye Test (Methylene Blue Test): A safe, simple procedure where a dye is instilled into the bladder to see if it leaks into the vagina.
- Cystoscopy (Bladder Endoscopy): Helps visualize the internal bladder wall and identify the exact fistula location.
- CT Urogram / MRI Pelvis: Used for complex or multiple fistulas, providing detailed imaging of surrounding structures.
The urology team at PACE Hospitals works closely with gynecology and radiology departments to ensure a comprehensive, accurate diagnosis before surgery.
Treatment Options for Vesicovaginal Fistula
The primary goal of Vesicovaginal Fistula repair is to close the fistula completely, restore normal urinary continence, and preserve vaginal function.
Conservative Management (Small Fistulas)
For small, recent fistulas (especially after surgery), a temporary urinary catheter may be used for 3–6 weeks to allow spontaneous healing. However, this works only in few cases.
Surgical Repair — The Definitive Treatment
If the fistula does not heal with conservative methods, surgical correction becomes necessary.
There are three primary approaches:
- Transvaginal Approach:
- Suitable for low, easily accessible fistulas.
- Shorter recovery but limited access for complex cases.
- Transabdominal (Open) Approach:
- Used for high or complex fistulas involving other organs.
- Involves a large incision and longer hospital stay.
- Laparoscopic Approach (Preferred Advanced Technique):
- Minimally invasive
- Uses 3–4 small incisions
- Allows precise visualisation and dissection
- Faster healing and superior cosmetic outcome
Pre-Operative Evaluation
Before surgery, patients undergo a complete evaluation at PACE Hospitals:
- Dye test (methylene blue) to confirm the fistula site.
- Cystoscopy to evaluate bladder and ureteric involvement.
- Urine culture and sensitivity to treat any infection before surgery.
- Routine preoperative investigations (CBC, renal function, blood sugar, coagulation profile).
- Anaesthetic and medical fitness assessment.
- Patient counselling regarding procedure and postoperative care.
Laparoscopic Vesicovaginal Fistula Repair – Step-by-Step
At PACE Hospitals, the laparoscopic procedure is the preferred option for most VVF cases. It provides great results with less pain and a quicker recovery.
Procedure Overview:
- Anesthesia: The patient is given general anesthesia for complete comfort.
- Port Placement: Small keyhole incisions are made to insert the laparoscope and instruments.
- Identification of Fistula: The bladder and vagina are carefully separated to locate the exact fistulous tract.
- Excision and Repair: The fistula tract is extracted and the bladder and vaginal walls are closed separately in layers using absorbable sutures.
- Interposition Flap (Optional): A tissue flap (usually omentum or peritoneum) may be placed between the bladder and vagina to enhance healing and reduce recurrence.
- Catheterisation: Urinary catheter is placed for 10-14 days after the completion of the surgery to allow proper healing of the bladder repair.
- Duration & Hospital Stay:
- Surgery Time: Approx. 2–3 hrs, depending on complexity of the condition
- Hospital Stay: 2–4 days
- Recovery: Most patients resume normal activities within 2–3 weeks.
Advantages of Laparoscopic VVF Repair
- Minimal invasive (small incisions and faster recovery)
- Less post-operative pain
- Shorter hospital stay
- Quicker return to work and daily activities
- Reduced infection risk
- Excellent cosmetic and functional results
Laparoscopy offers a magnified view, which helps surgeons operate with millimeter precision. This treatment ensures complete fistula closure and reduces the chances of recurrence.
Postoperative Care and Recovery
After surgery:
- Catheter care: Keep it clean and catheter to remain for 10–14 days to ensure proper healing.
- Fluid intake: Drink 2–3 litres of water daily.
- Hygiene: Maintain good perineal hygiene to prevent infection.
- Activity: Avoid straining and sexual activity until advised by the surgeon for at least 6–8 weeks.
- Follow-up: Regular check-ups with your urologist are important to monitor healing.
At PACE Hospitals Hyderabad, patients receive personalized recovery guidance from surgeons, nurses, and physiotherapists, ensuring a smooth post-surgical experience.
Risks and Possible Complications
While VVF repair surgery is generally safe in experienced hands, possible complications include:
- Bleeding or injury to nearby structures (ureters, bladder neck, urethra).
- Infection or wound dehiscence.
- Recurrence of fistula (persistent urinary leakage).
- Urinary incontinence or urgency after repair.
- Vaginal stenosis or dyspareunia (painful intercourse).
- Anaesthetic or general surgical risks (rare).
At PACE Hospitals, meticulous surgical approach and thorough intra-operative care help reduce these risks and ensure the best recovery.
Cost of Laparoscopic VVF Repair in Hyderabad
At PACE Hospitals, the total cost for Laparoscopic VVF Repair is determined by factors like the complexity of the fistula, any previous surgeries, the length of hospital stay, and the category
| Factors | Estimated Cost (INR): |
|---|---|
| Diagnostic evaluation (Labs, Cystoscopy, MRI ) | ₹15,000 – ₹30,000 |
| Laparoscopic VVF Repair Surgery | ₹1,60,000 – ₹2,80,000 |
| Hospital stay ( for 2-4 days) | Included |
| Total estimated package | ₹1,75,000 - ₹3,00,000 ($ 2,100 – 3,600) |
PACE Hospitals provides insurance support, EMI options, and cashless facilities for eligible plans
Success Rate and Results
At PACE Hospitals, Hyderabad, laparoscopic vesicovaginal fistula (VVF) repair has a success rate that exceeds 95%, thanks to:
- Advanced laparoscopic technology
- Experienced multidisciplinary surgical teams
- Thorough preoperative planning
- Complete follow-up care
Patients generally regain normal urinary continence and improved quality of life within weeks of recovery.
FAQs on Laparoscopic Vesicovaginal Fistula (VVF) Repair
What is a vesicovaginal fistula (VVF)?
A VVF is an abnormal opening between the bladder and vagina, causing continuous urine leakage. It's often due to surgery, childbirth, or trauma.
What causes vesicovaginal fistula?
VVF commonly occurs after hysterectomy, prolonged labour, pelvic radiation, or injury to the bladder during surgery.
How is a vesicovaginal fistula diagnosed?
Diagnosis involves a pelvic exam, dye test, cystoscopy, and imaging (CT or MRI) to locate the fistula and plan surgical repair.
What are the symptoms of a vesicovaginal fistula (VVF)?
Common symptoms include continuous urine leakage, vaginal wetness, foul discharge, recurrent infections, and pelvic discomfort are common symptoms.
What is laparoscopic VVF repair?
It's a minimally invasive surgery where the fistula is closed using keyhole incisions, offering faster recovery and minimal scarring.
What is the success rate of laparoscopic VVF repair?
At PACE Hospitals, the success rate exceeds 95%, with excellent recovery and restored continence.
How long is recovery after VVF repair?
Most of the patients recover within 2–3 weeks and can resume daily activities after catheter removal. Full healing takes around 6–8 weeks.
What are the benefits of laparoscopic surgery over conventional open surgery?
It offers smaller incisions, less pain, faster healing, lower infection risk, and better cosmetic outcomes.
How much does VVF repair cost in Hyderabad?
At PACE Hospitals, laparoscopic VVF repair costs ₹1,75,000–₹3,00,000 (USD 2,100–3,600) depending on the case and hospital stay.
Why choose PACE Hospitals for VVF treatment?
PACE Hospitals offers advanced laparoscopic facilities, experienced urology surgeons, 24×7 ICU care, and compassionate patient support for VVF repair.
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