Imagine leaking urine every day. You cannot control it. You cannot hide it.
That is life with a vesicovaginal fistula (VVF).
It is a devastating condition. Women with VVF often feel ashamed. They withdraw from family and friends. They lose jobs. They stop going to religious or social events.
But here is the good news. VVF is treatable. Most women get completely cured.
I have reviewed the latest medical research from 2024, 2025, and 2026. I will explain what VVF is, what causes it, and how doctors treat it. No fluff. Just facts.
A vesicovaginal fistula is an abnormal hole between the bladder and the vagina. This hole lets urine flow continuously from the bladder into the vagina. The woman cannot control or stop this leakage.
Think of it like a pipe with a crack. Water leaks out before reaching the end. The bladder fills normally, but urine escapes through the fistula before you can get to a toilet.
The most common symptom is constant wetness. Some women leak only a little. Others leak all the time. Either way, it destroys quality of life.
A 2022 study found that 97% of women with VVF screened positive for potential mental health problems. That number is shockingly high .
The cause depends on where you live.
In low and middle income countries, over 90% of VVFs come from obstructed labor. The baby gets stuck. Labor lasts for days. The pressure cuts off blood supply to the bladder and vagina. Tissue dies. A hole forms.
An estimated 2 million women live with untreated obstetric fistula worldwide. Each year, 50,000 to 100,000 new cases occur, mostly in Africa and South Asia .
The numbers are heartbreaking.
In high income countries, VVF is usually caused by surgery. Hysterectomy is the most common culprit. About 1 in 788 hysterectomies results in VVF. For radical hysterectomy for cervical cancer, the rate jumps to 1 in 87 .
Radiation therapy for pelvic cancer also causes VVF. About 0.6% to 2% of women who get radiation for cervical cancer develop a fistula. Sometimes the fistula shows up years after treatment ends .
Other causes include:
Cesarean section injury
Pelvic trauma
Self-inflicted injury (rare)
Infection or cancer
[Multimedia suggestion: A diagram showing a cross-section of the female pelvis with a VVF labeled. Show the bladder, vagina, urethra, and the abnormal connection between them. This helps patients understand their own condition.]
Doctors classify fistulas as simple or complex. This matters because it affects treatment.
Simple VVF is small (under 2.5 cm or about 1 inch). It has clean edges. No radiation damage. No previous failed repairs. No cancer.
Complex VVF is larger. Or it involves radiation damage. Or previous repairs failed. Or cancer is present. Or the hole is near the urethra or ureters.
A 2024 case report described a complex VVF measuring 3 cm (over 1 inch) from a self-inflicted injury. The patient cut her vaginal wall and bladder with scissors. That is a complex case .
Complex fistulas need more advanced surgery. Simple fistulas have better outcomes.
Not every VVF needs surgery right away.
Conservative treatment means placing a urinary catheter for continuous bladder drainage. The catheter stays in for 2 to 4 weeks. This works only for small, fresh fistulas under 1 cm.
The logic is simple. Keep the bladder empty. Urine stops flowing through the hole. The hole has a chance to heal on its own.
Studies show mixed success rates. Some report 12% to 80% closure with catheter drainage alone .
Best results happen when:
Fistula is diagnosed within 7 days of injury
Fistula is smaller than 1 cm
Catheter drains continuously for up to 30 days
No radiation or cancer is involved
If no improvement happens after 30 days, prolonged catheterization will not help. It only raises infection risk .
Other conservative options include:
Electrocoagulation (burning the tract to promote healing)
Fibrin glue injected into the fistula tract
Platelet-rich plasma
But evidence for these methods is limited. Most women need surgery .
[Data point: A 2025 review in the Bangladesh Journal of Urology reported on 48 VVF repairs. 46 patients (95.83%) had successful repair. Only 2 patients had recurrence. This shows that surgery works .
Surgeons used to wait 3 to 6 months before repairing a fistula. The idea was to let inflammation and swelling go down.
But that thinking is changing.
For simple surgical fistulas (like after hysterectomy), some surgeons now repair within 2 to 3 weeks. For obstetric fistulas, most still wait 3 to 6 months. For radiation fistulas, wait 6 to 12 months.
The Bangladesh study waited at least 12 weeks for primary repairs. Recurrent fistulas were repaired after 3 months .
A 2025 review in Current Opinion in Obstetrics and Gynecology notes that timing should balance tissue healing with the patient's suffering. No one wants to live with constant leakage longer than necessary .
Transvaginal repair is the most common approach for VVF. The surgeon works through the vagina. No cut on the belly. Less pain. Faster recovery.
For most VVFs, the vaginal approach is preferred. It has several advantages:
Shorter operating time
Less blood loss
Less postoperative pain
Shorter hospital stay
Lower cost
The Latzko procedure is a partial colpocleisis. The surgeon does not excise (cut out) the fistula tract. Instead, they bring healthy tissue over the hole and close it in layers. This shortens the vagina slightly. It works well for simple fistulas and previous failed repairs .
Multi-layered closure involves excising the fistula, mobilizing the bladder and vagina, then closing in layers. The bladder may close in one layer or two (mucosa and muscularis). The vaginal wall closes last.
A 2024 case report introduced a modified technique: double-layer parallel in-situ suturing. Instead of perpendicular sutures (which need wide separation), the sutures run parallel. This preserves blood supply. The patient in the report was cured and dry at 1-year follow-up .
[Multimedia suggestion: An infographic showing the difference between traditional perpendicular suturing and the new parallel in-situ technique. Label the blood supply and why parallel is better.]
Transabdominal repair is used when the fistula is high in the vagina, near the ureters, or when other abdominal surgery is needed. The surgeon opens the abdomen or uses laparoscopic or robotic tools.
There are two main abdominal approaches:
Transvesical (O'Connor technique) : The surgeon opens the bladder directly. They see the fistula from inside. They close the vaginal wall, then the bladder. This is considered the gold standard for complex cases .
Extravesical: The surgeon works between the bladder and vagina without opening the bladder. It is less invasive but technically harder.
When is abdominal repair chosen?
The 2025 Bangladesh study reported that 36 of 48 patients (75%) had transabdominal repair. The remaining 12 had transvaginal repair. The abdominal route was preferred for supratrigonal fistulas (high in the bladder) .
Another study recommends abdominal repair for:
Ureteric orifices close to the fistula (needs re-implantation)
Fistula too high to see from the vagina
Bladder augmentation needed
Multiple or complex fistulas
Laparoscopic and robotic VVF repair are newer options. They offer the benefits of abdominal repair (good visualization) with less pain and faster recovery than open surgery.
Laparoscopic repair is technically challenging. Suturing inside the pelvis through small holes takes skill.
Robotic assistance makes it easier. The robot gives 3D vision, tremor control, and better dexterity. The surgeon sits comfortably at a console.
A 2025 review notes that minimally invasive approaches are increasing and result in similarly high success rates with lower patient morbidity compared to open abdominal surgeries .
The Bangladesh authors note they still use open procedures due to lack of equipment and training. But they acknowledge robotic repair is the future .
Sometimes closing the hole is not enough. The repair needs reinforcement.
A tissue interposition flap is a piece of healthy tissue placed between the bladder and vaginal repairs. It adds blood supply and a protective layer. The Martius flap (fat from the labia majora) is the most common.
The Martius flap was first described in 1928. Today, it refers to a fat pad from the labia majora. The surgeon makes a small cut in the labium. They free the bright yellow fibrofatty tissue. They tunnel it under the vaginal wall to the fistula repair site. The flap covers the suture lines .
When is a flap used?
Recurrent fistulas (failed previous repair)
Radiation-induced fistulas (poor tissue quality)
Large or complex fistulas
Fistulas with little healthy tissue between bladder and vagina
In the Bangladesh study, flaps were used in only 5 of 48 cases (10.41%). Most primary repairs did not need them .
Other flap options include gracilis muscle, gluteal muscle, and peritoneal grafts .
[Multimedia suggestion: A step-by-step illustration of the Martius flap procedure. Show the labial incision, fat pad harvest, tunneling, and final placement over the fistula repair.]
The ureters carry urine from kidneys to bladder. They sit close to the bladder wall. If a fistula is near a ureter, surgery could injure it.
Double-J stents are thin tubes placed in the ureters before VVF repair. They protect the ureters during surgery. The surgeon can see and feel them. They prevent accidental injury.
In the 2024 case report of a complex VVF, the surgeon placed bilateral Double-J stents before starting the repair. The fistula was only 2 cm from the left ureter. The stents prevented disaster .
In the Bangladesh study, only 3 of 48 patients (6.25%) needed stents. Most fistulas were far enough from the ureters .
Stents are removed a few weeks after surgery.
Surgery is only half the battle. Proper aftercare determines success.
After VVF repair, a urinary catheter stays in for 7 to 21 days. The bladder must stay empty. No pressure. No stretching. The repair needs time to heal.
The Bangladesh study kept catheters for 14 to 21 days .
Other postoperative steps include:
Antibiotics to prevent infection
Bladder irrigation to prevent clots
Avoiding constipation (straining puts pressure on the repair)
Pelvic rest (no intercourse for 6 to 8 weeks)
No heavy lifting
The patient in the 2024 case report had vaginal sutures removed on day 24. She was completely dry. At 1 year, no recurrence .
VVF repair has high success rates. Most women get completely cured.
For primary (first-time) VVF repair, success rates range from 75% to 97%. The Bangladesh study reported 95.83% success (46 of 48 patients).
Only 2 patients (4.16%) had recurrence .
Failure is more common with:
Radiation-induced fistulas
Large fistulas (over 3 cm)
Previous failed repairs
Poor tissue quality
Infection
Most failures happen within 3 months of repair .
If the first repair fails, a second repair is still possible. Success rates are lower but still good with experienced surgeons.
VVF repair is safe. But complications happen.
Common complications include urinary tract infection (8.33% in the Bangladesh study), significant hematuria (4.16%), and transient incontinence (6.25%).
Serious complications are rare. They include:
Recurrent fistula (4.16%)
Ureteric injury
Bladder perforation
Blood transfusion needed
Deep vein thrombosis
The Bangladesh study had no deaths. No major complications requiring reoperation .
Most VVFs are preventable.
In low-resource settings, preventing obstructed labor is key. This means access to emergency cesarean section, trained birth attendants, and family planning.
In high-income countries, prevention means careful surgical technique during hysterectomy and pelvic surgery. Recognize bladder injuries early. Repair them immediately.
For radiation-induced fistulas, prevention is harder. Newer radiation techniques (image-guided adaptive brachytherapy) have lower fistula rates. The modern incidence is about 0.7% in women without bladder invasion .
Q: Can a vesicovaginal fistula heal on its own without surgery?
A: Rarely. Small fistulas under 1 cm diagnosed within a week of injury may heal with continuous bladder drainage for 30 days. But most fistulas need surgery. If no improvement after 30 days of catheterization, spontaneous healing will not happen .
Q: How long does VVF repair surgery take?
A: Simple transvaginal repairs take 1 to 2 hours. Complex abdominal repairs take 2 to 4 hours. Robotic cases may take longer due to setup time.
Q: Will I be able to have children after VVF repair?
A: Yes, but with caution. Obstetric fistula often damages the uterus and surrounding tissue. Pregnancy after repair is possible but carries higher risks. Most experts recommend cesarean delivery for future pregnancies. Discuss with your surgeon.
Q: How do I know if my VVF has returned after surgery?
A: The main sign is urine leakage from the vagina again. It may start soon after catheter removal or weeks later. Your doctor will perform a dye test (placing blue dye in the bladder and checking the vagina for blue staining). Cystoscopy confirms the diagnosis.
Q: What is the difference between VVF and stress incontinence?
A: Stress incontinence leaks urine with coughing, sneezing, or exercise. VVF leaks all the time, continuously, regardless of activity. A simple office test (tampon test with dye) tells the difference.
Q: Will my insurance cover VVF treatment?
A: Yes, in most countries. VVF is a recognized medical condition. Treatment is medically necessary. Contact your insurance provider for specific coverage details. For women in low-resource settings, many charitable organizations offer free fistula repair camps.
VVF is a devastating condition. It isolates women. It destroys dignity. It steals joy.
But it is treatable.
Most women who get proper surgical repair become completely dry. They return to normal life. They go back to work. They hug their children without fear.
The key is getting to a skilled surgeon. Transvaginal repair works for most cases. Abdominal or robotic repair works for complex ones. Success rates exceed 95% for primary repairs.
Do not suffer in silence. Do not wait years. Help is available.
If you or someone you know has continuous urine leakage after childbirth, hysterectomy, or pelvic surgery, see a urologist or gynecologist. Ask about VVF. Get evaluated. Get treated.
You do not have to live this way.
Medicine (Baltimore). "Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report." 2024;103(41):e39881.
Medscape. "Vesicovaginal Fistula Treatment & Management." Updated March 2025.
Bangladesh Journal of Urology. "Outcome of Surgery in Both low & High Variety of VVF." 2025;28(1):10-15.
Current Opinion in Obstetrics and Gynecology. "Contemporary genitourinary fistula management: treatment, trends, and innovations." December 2025;37(6):432-437.
Taylor & Francis. "Transvaginal Repair of VVF." Textbook of Female Urology and Urogynecology. 2023.
Spurlock J, Isaacs C. "Vesicovaginal Fistula." Medscape. 2025.