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Thousands of clinical compensation claims are initiated every year in the United Kingdom by medical negligence solicitors on behalf of people from all walks of life. A multitude of operations and procedures are executed successfully however a small percentage do go wrong, laying the grounds for medical negligence solicitors to take legal action in order to claim compensation. Both legal aid and the no win no fee* scheme are available for solicitors to pursue medical negligence compensation claims for a vesico vaginal fistula.

Our medical negligence solicitors operate the no win no fee* scheme otherwise known as a conditional fee agreement. No legal charge is payable unless the legal case is won and the client obtains an award of compensation. In the event that the legal claim is lost there is no charge made to the client. Please contact us for help pursuing your vesico vaginal fistula compensation claim.

Vesico Vaginal Fistula Information

A vesicovaginal fistula and the related condition, ureterovaginal fistula, are complications of female pelvic surgery. About half of all fistulas occur as a result of a hysterectomy, which is done for things like uterine fibroid tumors, menstrual dysfunction and prolapse of the uterus. It results in leakage of the urine from the vagina and the appearance of urinary incontinence. A small percentage of vesicovaginal/ureterovaginal fistulas occur as a result of radiation to the pelvis. These can occur months or even years after the initial event.

Vesicovaginal fistulas are not new. Hippocrates defined this condition many centuries before and it was believed to be due to difficult vaginal births. Now it is mainly due to errors made in surgery to the pelvis in developed countries. In developing countries, there are still vesicovaginal fistulas from obstetrical trauma. The goal of treating vesicovaginal deliveries, according to J. Marion Sims, is to rid the area of all scar tissue, get fresh margins of tissue and to close the tract without overlapping suture lines.

Doctors can repair a vesicovaginal fistula using transabdominal or transvaginal approaches. Sometimes it is not easily repaired using a transvaginal approach and doctors must open up the abdomen to get the best visualization of the bladder and the vagina. This is especially true when the condition is a ureterovaginal fistula. The ureter is difficult to see and fix in a vaginal procedure. In addition, fistulas that are high on the bladder wall (above where the ureters enter) must be done abdominally. Regardless of the position of the fistula, many doctors prefer the abdominal approach. On the other hand, the vaginal approach is more comfortable and preferable by the patient.

A vesicovaginal fistula and a ureterovaginal fistula are holes or areas of connection between the urinary tract system and the vagina. Urine from the urinary tract can flow freely from the urinary tract to the vagina, resulting in leakage of the urine through the vagina and the appearance of urinary incontinence. If the hole is between the ureter and the vagina, the urine bypasses the bladder altogether and flows into the vagina. The incidence of vesicovaginal fistula as a result of a hysterectomy is about one percent or less. Ten percent of these actually come from one or both ureters. Some fistulas are very complicated and go through more than one organ system before reaching the bladder, including having a portion of the bowel involved in the fistula.

The usual cause of a vesicovaginal fistula is an unrecognized bladder injury while a hysterectomy or other pelvic surgery is performed. Cesarean sections can cause bladder injuries. It is when the doctor creates what's known as a bladder flap that excessive dissection can occur, resulting in a puncture or tear of the bladder wall. The bladder wall is extremely thin and is easily injured. In addition, doctors can do a vaginal cuff suture during a vaginal hysterectomy and this can incorporate a part of the bladder into it, resulting in a natural connection between the bladder and the vagina. There needs to be a loss of circulation to the affected area that causes necrosis or tissue death. This is what creates the "hole" between the two different structures. The surgeries that were considered the most difficult and which results in the most bleeding and necessity for extra repair are those that result in vesicovaginal fistulas. The urinary incontinence can be immediate or can take place days or weeks after the surgery is over with.

The treatment of vesicovaginal fistulas and ureterovaginal fistulas involves surgical repair followed by the placement of a urinary/bladder catheter to give the bladder and ureters a rest and to decrease the pressure of the urine on the bladder. The catheter may need to be placed for weeks and/or months in order to allow the bladder to heal.



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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here