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Classification – Urinary Fistula


Vesicovaginal Fistula

Uretero Vaginal Fistula

Urethro Vaginal Fistula


VVF is the m/c urinary fistula




In developing countries - Obstructed


It is due to ischemic necrosis, so develops 3-5days after delivery.

In Developed countries - hysterectomy


Maximum risk is with

Wertheims hysterectomy

No continuous leakage but

when patient urinates, urine leaks from urethra and vagina.

Chief Complaint

Continuous dribbling of urine from vagina + no normal urge for urination

Continous dribbling of urine from vagina + normal urge

for urination

Lower most cotton plug is

wet with dye, other two are


Methylene blue 3 swab test (M oirs test)

Middle cotton plug is wet with dye and urine (blue in colour)

Uppermost cotton plug is wet with urine but not with dye.

Other 2 cotton swabs are dry


Investigation of choice


Dye test with indigo carmine demonstrates urinary extravasation and identifies the location of injury + Cystoscopy


Mgt of Choice-Surgery

Technique: Layer technique/ Latzko repair (for post hysterectomy VVF repair)

chassar moir technique

Time of surgery: If it is due to obstructed labor repair should be done after 3 months. (so that infection and

inflammation subside)

If it is due to surgery and is recognised within 24 hours-

Immediate repair. If recognised later-repair after 10-12 weeks Radiation fistulas are repaired after 12 months

Boari Flap technique




As early as possible



Vesicovaginal Fistula

  • Prolonged and obstructed labor is the MC cause of vesicovaginal fistula (VVF) in India.
  • It is due to ischemic necrosis, so it develops 3-5 days following delivery.
  • In developed countries, the MC cause is postsurgery.
  • Patients with VVF present with continuous incontinence with no urge to pass urine. Patients with ureterovaginal fistula also present with continuous incontinence, but there is an urge to pass urine.
  • Patients with urinary fistula may also have secondary amenorrhea (hypothalamic origin), which gets corrected following successful repair of fistula.

MOIR's Three Tampon (Swab) Test

  • Patient is placed in dorsal lithotomy or knee chest position
  • Three cotton tampons are placed in the vagina
  • Methylene blue is instilled into the bladder
  • Patient made to walk for 10-15 min
  • Tampons removed and examined





Upper most swab is soaked with urine (not with dye), lower two are dry

Ureterovaginal fistula

Middle swab is wet with dye (blue in color); other two are dry

Vesicovaginal fistula

Lowest swab is wet with dye (blue); other two are dry

Urethrovaginal fistula

  • Surgery for closure of VVF is layer technique.
  • The ideal time to do the surgery is 3-6 months following delivery.
  • Fistula formed during surgery is to be closed immediately if detected during the operation.
  • If the fistula is detected in the postoperative period, it is to be closed after 3-6 months.
  • Surgery for closure of posthysterectomy VVF= Latzko technique (layer technique + partial colpocleisis).

Youssef’s Syndrome


Menuria (menses in urine / cyclical hematuria) is seen in uterovesical fistula. Menuria is also seen in vesical endometriosis.

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