Vesicovaginal fistula after hysterectomy

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Diagnosing a vesicovaginal fistula depends a lot on the patient’s history, typically involving absolute urinary incontinence during the day and during the night since the surgical intervention.

The following images and videos represent an abnormal passageway between the bladder and the vaginal apex following a complicated hysterectomy.

vesicovaginal fistula ultrasound
Imaging of two cavities containing clear fluid (urine) and of the small connection between them (fistula) sets the diagnosis.
The fistula is small enough that the bladder isn’t always empty, but its existence causes permanent urinary incontinence.
vesicovaginal fistula blue
The gold standard in the diagnosis of a vesicovaginal fistula is filling the bladder with a dilute solution of methylene blue and watching the colored urine flow through the fistula in the vagina.

Bibliography

  • Volkmer, B. G., Kuefer, R., Nesslauer, T., Loeffler, M., & Gottfried, H. W. (2000). Colour Doppler ultrasound in vesicovaginal fistulas. Ultrasound in medicine & biology, 26(5), 771–775. https://doi.org/10.1016/s0301-5629(00)00210-6
  • Sohail, S., & Siddiqui, K. J. (2005). Trans-vaginal sonographic evaluation of vesicovaginal fistula. JPMA. The Journal of the Pakistan Medical Association, 55(7), 292–294.
  • Stamatakos, M., Sargedi, C., Stasinou, T., & Kontzoglou, K. (2014). Vesicovaginal fistula: diagnosis and management. The Indian journal of surgery, 76(2), 131–136. https://doi.org/10.1007/s12262-012-0787-y

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