vaginal fistula
A vaginal fistula is an abnormal, tortuous opening between the vagina and
.)another hollow organ (see Figure 22-2
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Pathophysiology and Etiology:
Causes
 Obstetric injury, especially in long labors and in countries with
inadequate obstetric care.
 Pelvic surgery ,hysterectomy or vaginal reconstructive procedures.
 Carcinoma extensive disease or complication of treatment such as
radiation therapy.
 Pelvic radiotherapy - such as for pelvic cancer
Types
 Vesicovaginal fistula is an opening between the bladder and vagina.
 Rectovaginal fistula is an opening between the rectum and vagina.
 Ureterovaginal fistula is an opening between the ureter and vagina.
 Urethrovaginal fistula is an opening between the urethra and vagina.

Vaginoperineal fistula is an opening between the vagina and
perineum.
Clinical Manifestations
1.Vesicovaginal is the most common type of fistula
 Constant trickling of urine into vagina.
 Loss of urge to void because bladder is continuously emptying.
 May cause excoriation and inflammation of vulva.
 Watery vaginal discharge
 Constant leakage of urine from vagina
2. Rectovaginal.
 Fecal incontinence and flatus through the vagina; malodorous.
 May present as vulvar cancer.
3.Ureterovaginal fistula rare.
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 Urine leaking in vagina during urination but patient still voids
regularly.
 May cause severe UTIs.
4.Urethrovaginal fistula.
 Dysuria.
 Urine in vagina on voiding.
5.Vaginoperineal fistula: pain and inflammation of perineum.
Diagnostic Evaluation
 Methylene blue test after instillation of this dye in bladder.
 Methylene blue appears in vagina in vesicovaginal fistula .
 Methylene blue does not appear in vagina in ureterovaginal
fistula
 Indigo carmine test after a methylene blue test shows negative
results, indigo carmine is injected intravenously. If dye appears
in vagina, this indicates ureterovaginal fistula
 I.V. urography helps detect presence and location of fistula,
hydroureter, and hydronephrosis.
 Cystoscopy performed to determine number and location of
fistula .
Management
 Fistulas recognized at time of delivery should be corrected
immediately.
 Treatment of postoperative fistula may be delayed for 2 to 3 months
to allow treatment of infection.
 Surgical closure of opening via Vaginal or abdominal route (when
patient's tissues are healthy).
 Fecal or urinary diversion procedure may be required for large fistula .
 Rarely, a fistula may heal without surgical intervention.
 Medical approach.
 Prosthesis to prevent incontinence and allow tissue to heal;
done for patients who are not surgical candidates.
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 Prosthesis is inserted into vagina; it is connected to drainage
tubing leading to a leg bag.
Complications
Hydronephrosis, pyelonephritis, and possible renal failure with
ureterovaginal fistula
Nursing Assessment
 Obtain obstetric, gynecologic, and surgical history.
 Monitor intake and output and voiding pattern.
 Assess drainage on perineal pads.
 Watch for signs of infection (fever, chills, flank pain).
Nursing Diagnoses
 Risk for Infection related to contamination of urinary tract by flora or
contamination of the vagina by rectal organism
 Impaired Urinary Elimination related to fistula
Nursing Interventions
Preventing Infection
 Encourage frequent sitz baths.
 Perform Vaginal irrigation as ordered, and teach patient the
procedure.
 Before repair surgery, administer prescribed antibiotics to reduce
pathogenic flora in the intestinal tract.
 After rectovaginal repair
 Maintain patient on clear liquids as prescribed to limit bowel
activity for several days.
 Encourage rest because of debilitation.
 Administer warm perineal irrigations to decrease healing time
and increase comfort.
Maintaining Urinary Drainage
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 Suggest the use of perineal pads or incontinence products
preoperatively.
 After vesicovaginal repair
 Maintain proper drainage from indwelling catheter to prevent
pressure on newly sutured tissue.
 Administer Vaginal or bladder irrigations gently because of
tenderness at operative site.
 Maintain strict intake and output records.
 If medical management is indicated, teach patient the use of prosthetic
device.
 Encourage patient to express feelings about her altered route of
elimination and share them with significant other.
Patient Education and Health Maintenance
 Teach patient to report signs of infection early.
 Teach patient to clean perineum gently and to follow surgeon's
instructions on when to resume sexual intercourse and strenuous
activity.
 Advise patient to keep regular follow-up appointments.
Evaluation: Expected Outcomes
 No signs of infection a febrile, no complaints of flank pain or
difficulty voiding
 Clear urine flows from catheter postoperatively; voids without
difficulty after catheter removal
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