Vesicovaginal and Ureterovaginal Fistula Repair
Repair of fistulas causing continuous urinary leakage. This is not a personal failing but a repairable medical condition — and the two things that matter most are correct timing and getting the first repair right.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 1.5–3 hours depending on the site
- Anesthesia
- General or spinal anaesthesia
- Hospital stay
- 1–3 nights
- Stay in Türkiye
- 3–4 weeks (the catheter is removed here)
- Catheter duration
- 2–3 weeks
- Return to work
- 3–4 weeks
- Flight clearance
- After catheter removal and review
About the condition
A fistula is an abnormal connection between two structures that should be separate. Here it is a connection between the bladder and the vagina (vesicovaginal) or between a ureter and the vagina (ureterovaginal). The result is continuous, uncontrollable leakage of urine.
LET US SAY THIS PLAINLY FIRST: THIS IS NOT YOUR FAULT AND IT IS NOT SOMETHING TO BE ASHAMED OF. A fistula is a medical complication that can follow a difficult or prolonged labour, gynaecological surgery such as hysterectomy, pelvic surgery or radiotherapy. In most cases it can be repaired completely.
HOW THE SYMPTOM IS RECOGNISED: in other types of urinary leakage, the leak occurs in specific circumstances — on coughing, laughing, or after a sudden urge. With a fistula the leak is continuous; even if you pass urine normally, there is constant wetness in between. The distinction matters, because a description of constant wetness should bring a fistula to mind immediately.
THE MOST IMPORTANT SENTENCE: THE FIRST REPAIR IS THE BEST CHANCE OF REPAIR. Every failed attempt degrades the tissue, leaves scar and lowers the success rate of the next one. "Let us try and see, we can look again if it fails" is not the right approach in this condition. The first repair should be performed in experienced hands and at the right time.
TIMING IS PART OF THE DECISION. If the fistula is recent and the surrounding tissue is inflamed, oedematous and still healing from surgery, an immediate repair is prone to fail. A period of waiting may be needed for the tissue to settle. That wait is hard on the patient, and the question "why not now" is entirely fair — but a hurried repair that breaks down costs more than waiting.
Who is it suitable for?
May be suitable
- Women with continuous urinary leakage beginning after gynaecological or pelvic surgery
- Women describing continuous leakage after a difficult or prolonged labour
- Women who have developed a fistula after radiotherapy — this group requires separate assessment
- Women whose previous repair has not stopped the leakage
- Women with more than one fistula opening
- Women leaking because of ureteric injury
May not be suitable
- The early period while tissue is still inflamed and oedematous: repair is deferred, and that is part of the plan rather than a delay
- Women with untreated urinary infection: the infection is treated first
- Women who cannot accommodate the catheter period and the length of stay — the catheter time in this repair cannot be shortened
- Where there is active cancer, the plan is made separately and alongside oncological treatment
Technology used
- Cystoscopy — to establish the site and number of fistula openings and their distance from the ureteric orifices
- CT urography — to assess the ureters
- Dye testing — to distinguish leakage from the bladder from leakage from a ureter
- Renogram — to assess renal function where a ureter is involved
- Vaginal or abdominal approach according to the site
- Tissue interposition (for example a Martius flap) — placing healthy, well-vascularised tissue between the suture lines
- Reimplantation of the ureter into the bladder
Surgeon's experience
Verifiable information
- Redo (repeat surgery) rate
- A substantial proportion of cases are redo repairs following a failed procedure or iatrogenic injury elsewhere.
- Complex case definition
- Post-radiotherapy fistula, large or multiple fistulas and repeated failed repair fall within the complex category.
- Advanced technique used
- Vaginal or abdominal repair supported by tissue interposition (for example a Martius flap); ureteric reimplantation.
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Confidential review of your file
Your history, YOUR PREVIOUS OPERATION NOTES and your imaging are reviewed in confidence. When the leakage began and which operation it followed is the single most important piece of information.
- Days 1–2
Arrival and assessment
Examination, cystoscopy and imaging establish the site, size and number of fistulas and distinguish bladder from ureteric leakage. On request, a female member of staff is present throughout.
- Day of surgery
Repair
A vaginal or abdominal approach according to the site. Where tissue quality is poor, healthy well-vascularised tissue is placed between the suture lines to make the repair more durable.
- Catheter period
2–3 weeks
The catheter stays while the repair heals. The period is not arbitrary: a distended bladder stresses the repair and can cause it to leak. It is mostly spent at the hotel.
- Catheter removal
Check
The integrity of the repair is checked before the catheter is removed. If there is any doubt, the catheter stays longer — so keep your return ticket flexible.
- Follow-up
Long term
Confirming that the leakage has stopped completely and assessing continence. In some women a different type of urinary leakage remains after the fistula closes; that is assessed separately and has its own treatment.
Method comparison
| Criterion | Fistula leakage | Stress incontinence | Urgency incontinence |
|---|---|---|---|
| When the leak occurs | Continuously, not situation-dependent | Coughing, laughing, lifting | After a sudden urge |
| At night | Continues; the bed becomes wet | Usually not | Possible |
| Normal voiding | Possible, but with constant wetness in between | Normal | Frequent and urgent |
| When it began | Usually after an operation or childbirth | Insidiously over years | Insidiously over years |
| First diagnostic step | Cystoscopy and dye test | Examination and bladder diary | Bladder diary |
The distinction matters because the treatments are entirely different. Continuous wetness that is not situation-dependent and began after an operation or childbirth should be treated as a fistula until proved otherwise.
Risks
- BREAKDOWN OF THE REPAIR: more likely in fistulas following radiotherapy, in large fistulas and where a previous repair has failed
- Infection and bleeding
- Temporary difficulty passing urine after catheter removal
- A sense of reduced bladder capacity and frequency — particularly where there is a history of radiotherapy
- A DIFFERENT TYPE OF LEAKAGE MAY REMAIN EVEN AFTER A SUCCESSFUL REPAIR: the fistula closes, but damage to the underlying support tissue can leave stress incontinence. This does not mean the repair failed; it is a separate condition with its own treatment. Knowing this in advance prevents later disappointment
- Discomfort during intercourse — particularly in the early period after a vaginal repair or where a flap was used
- Stricture where a ureter has been repaired
- The need for further repair in very complex and recurrent cases
Alternatives
- Waiting for spontaneous closure with prolonged catheterisation — only for very small and very recent fistulas in selected patients
- Planned waiting for tissue to settle before repair — not a delay but a decision that improves the chance of success
- Vaginal repair — for suitably located fistulas; recovery is quicker
- Abdominal repair — for high, ureter-adjacent or complex fistulas
- Tissue-supported (flap) repair — where tissue quality is poor and in recurrent cases
- Reimplantation of the ureter into the bladder — for ureterovaginal fistula
- Permanent urinary diversion — only in very advanced and exceptional situations where repair is not possible
Recovery
First days
Discharge with the catheter. Keeping the catheter unblocked is critical: if the bladder fills and distends, the repair is stressed. Plenty of fluids are therefore advised.
Catheter period (2–3 weeks)
Lifting, straining and constipation are to be avoided. Fibre and fluids matter. If the catheter blocks or comes out, or if vaginal wetness returns, seek help without delay.
Catheter removal
The integrity of the repair is checked beforehand. Frequency is usual in the first days afterwards.
Weeks 4–6
Return to daily life. For intercourse, follow the interval your surgeon gives you; resuming early can stress the repair. Some discomfort is possible at first after a vaginal repair.
Month 3 onwards
Confirmation that leakage has stopped completely. If a different type of incontinence remains at this point, it is assessed and treated separately.
Frequently asked questions
Is this permanent, and is it something to be ashamed of?
No, in no sense. A fistula is a medical complication, not a personal failing or the result of negligence on your part, and in most cases it can be repaired completely. Many women carry this for years without telling anyone — when it is a treatable condition.
I am constantly wet but I can still pass urine normally. Could it be a fistula?
Yes, and that is a common picture. With a fistula part of the urine leaves normally and part leaks continuously. Constant wetness that is not situation-dependent and began after an operation or childbirth should bring a fistula to mind.
Why am I not being operated on straight away?
This is a fair question and the most frequently asked. If the fistula is recent, the surrounding tissue is inflamed and oedematous, and a repair in that tissue is prone to break down. Waiting for the tissue to settle is part of the plan, not a delay. We know the wait is difficult, but a hurried repair that fails costs more.
I have had one repair already and I am still leaking — can it be repaired again?
In most cases yes. To be honest, though, each failed attempt degrades tissue quality and lowers the success rate of the next. The second repair is therefore planned more carefully and usually requires a tissue-supported technique. Your previous operation note is the most important document in that plan.
What is a flap and why is it needed?
A repair joins two tissue layers with sutures. Where tissue quality is poor — for instance in an irradiated or previously operated field — a piece of healthy, well-vascularised tissue is placed between those layers. The aim is to separate the suture lines and support healing. It is not an "extra procedure" but a step that makes the repair more durable.
I have had radiotherapy — does that affect the repair?
Yes, and it should be said plainly. Irradiated tissue has reduced blood supply and healing capacity; the chance of the repair breaking down is higher in these cases and a tissue-supported technique is almost always required. Expectations need to be built on that reality.
Why does the catheter stay so long?
A bladder that fills and distends stresses the suture line and can cause a leak. The catheter keeps the bladder empty so the repair can heal. This period is not shortened to suit a flight, and keeping the catheter unblocked is equally critical.
Will my leakage stop completely after the repair?
The continuous leakage caused by the fistula is expected to stop. In some women, however, damage to the underlying support tissue leaves a different type of leakage — for instance on coughing. That does not mean the repair failed; it is a separate condition with its own treatment. Knowing this in advance prevents later disappointment.
Will this be confidential, and can I ask for female staff?
Yes to both. You may ask for a female member of staff to be present at examinations and consultations and for a female medical interpreter; saying so when you book is enough. Your medical information is not shared with anyone without your consent, including your companion. If you are asked for photographs or a testimonial you may refuse, and it will not affect your treatment.
What should I send?
When the leakage began and after which operation or delivery, all of your previous operation notes, records of any previous repair, cystoscopy and imaging results, whether you have had radiotherapy, renal function tests and your medication. A history of radiotherapy and the number of previous repairs are the two pieces of information that change the plan most.
Scientific sources
This page is for general information only and is not a substitute for medical advice.
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