Vesicovaginal fistula repair
Surgery to close an abnormal opening between the bladder and the vagina that lets urine leak out of the vagina all the time. It can be done through the vagina or through the belly, often robotically, and you keep a catheter for about 2 to 3 weeks while it heals.
Also called VVF repair, vesicovaginal fistula, bladder vaginal fistula, hole between bladder and vagina, urine leaking from the vagina, constant leaking after hysterectomy, fistula surgery, genitourinary fistula repair
- Where
- Hospital operating room
- Anesthesia
- General anesthesia (spinal anesthesia is sometimes used for a vaginal repair)
- Time in the room
- About 1.5 to 4 hours, depending on the approach and the fistula
- Hospital stay
- Same day to one night after a vaginal repair; usually 1 to 3 nights after a belly approach
- Going home with
- A catheter in the urethra, sometimes with a second tube through the lower belly, for about 2 to 3 weeks
- Back to normal
- About 4 to 6 weeks
- Back to work
- About 2 to 4 weeks for desk work (many wait until the catheter is out), about 6 weeks for heavy work
Overview
A vesicovaginal fistula is an abnormal opening between the bladder and the vagina. Urine passes through it and leaks out of the vagina, often all day and night, no matter how often you empty your bladder. It is distressing, and in most cases it can be repaired.
In the United States, most fistulas follow a hysterectomy or other pelvic surgery, and the leak usually starts in the first few weeks afterward. Others follow radiation treatment for cancer, sometimes years later. Worldwide, the most common cause is a long, blocked labor without timely access to a cesarean section (obstetric fistula).
The repair closes the opening in separate layers: the bladder, often a pad of healthy tissue, and then the vagina. Your surgeon can do this through the vagina or through the belly (open, laparoscopic, or robotic). The choice depends on where the fistula sits, how large it is, whether it has been repaired before, whether a ureter (the tube from a kidney) is involved, and your surgeon's experience. Both routes work well in experienced hands.
The first repair has the best chance of success, so careful planning matters. For fistulas after surgery in tissue that has not had radiation, most first repairs succeed, more than 9 out of 10 in experienced centers.
The parts of your body involved
The bladder sits in front of the vagina, separated by a thin layer of tissue. After a hysterectomy, the top of the vagina (the vaginal cuff) lies right behind the base of the bladder. If this area is injured or does not heal well, a tunnel can form between the two. The ureters, which carry urine from the kidneys, enter the bladder close to this area, so the surgeon checks them carefully.
- Bladder
Stores urine. The fistula opens through its back wall, usually near its base.
- Vagina and vaginal cuff
The vaginal cuff is the closed top of the vagina after a hysterectomy, a common site for a fistula.
- Fistula
The tunnel between the bladder and the vagina. Some are pinhole-sized; others are larger.
- Ureters
The tubes from the kidneys. They enter the bladder close to most fistulas and must be protected.
- Urethra
The normal outlet of the bladder. A catheter rests in it during healing.
- Tissue flaps
Healthy tissue that can be moved between the bladder and the vagina to help the repair heal: a fat pad from the outer lip of the vagina, the lining of the belly, or the omentum (a fatty apron inside the belly).
Why it’s done
Once a fistula has formed a mature tunnel, it rarely closes on its own, and surgery is the main treatment. A small, fresh fistula sometimes heals with a catheter left in the bladder for several weeks, so your doctor may try that first.
- Constant leaking
Urine leaks from the vagina day and night, soaking pads and clothing.
- Sore skin and infections
Constant wetness irritates the skin of the vulva and thighs and can lead to rashes and infections.
- Quality of life
Many women withdraw from work, friends, exercise, and intimacy because of the leaking and worry about odor.
- Protecting a kidney
If a ureter is also involved, it may need to be repaired or reconnected to the bladder to protect the kidney.
- Checking for cancer
After radiation or cancer treatment, a biopsy of the fistula edge is often taken to make sure cancer has not returned.
Other options
- Catheter drainage alone
For a small, fresh fistula, keeping the bladder empty with a catheter for several weeks sometimes lets it heal without surgery.
- Waiting for the right time
Some fistulas are repaired within weeks; others are repaired after waiting a few months for inflammation to settle. After radiation, surgeons often wait longer.
- Pads and skin protection
Absorbent products and barrier creams protect the skin while you wait for surgery or if you choose not to have it.
- Ureteral stent
If the leak comes from a ureter rather than the bladder, a stent placed inside the ureter sometimes lets it heal without open repair.
- Urinary diversion
Rarely, for very large fistulas after radiation that cannot be repaired, urine is rerouted away from the bladder.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia and positioning
You go to sleep and lie on your back with your legs in padded stirrups. For a robotic repair, the table is also tilted head-down. The area is cleaned and draped.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
Right afterward
- The catheter comes first
The catheter must drain freely at all times so the bladder never fills and strains the repair. Nurses check it often.
- Vaginal packing
Any packing is removed the next morning.
- Bladder spasms
Cramping is common. You may be given medicine to calm the bladder.
- Pain control
Pain is usually controlled with pills after a vaginal repair, and with IV medicine for the first day after a belly repair.
- Eating and walking
You eat and walk soon after a vaginal repair. After a belly repair, eating returns over a day or so.
- Going home
You go home once you are comfortable, eating, and confident with catheter care.
At home
- Catheter care
Keep the catheter draining day and night for about 2 to 3 weeks. Keep the bag below your bladder, avoid kinks, never clamp the tubing, and empty the bag before it is full.
- Bladder spasms
Take the spasm medicine as directed. Urine may leak around the catheter during a spasm.
- Fluids
Drink enough to keep your urine pale, which helps the catheter drain well.
- Bowels
Take a stool softener and avoid straining.
- Pain
Use acetaminophen and, if allowed, ibuprofen. Take stronger medicine only as prescribed.
- Vaginal care
Light spotting and discharge are normal. Nothing in the vagina (no sex, tampons, or douching) for at least 6 weeks, or longer if your surgeon advises.
- Activity and lifting
Walk every day. Avoid heavy lifting (more than about 10 to 15 pounds) and hard exercise for about 6 weeks.
- Showering
You can shower. No baths, hot tubs, or swimming until your surgeon clears you.
- Driving
You can drive once you are off opioid pain medicine and can move comfortably.
- Catheter removal
Before the catheter comes out, an X-ray with dye in the bladder (cystogram) checks that the repair is watertight. If there is a small leak, the catheter usually stays longer while it heals.
Recovery timeline
- Day 0Surgery
You wake up with a catheter, and sometimes vaginal packing and a second tube.
- Days 1 to 3Home
Packing out. Home the same day or within a few days, depending on the approach.
- Week 1Resting and healing
Bladder spasms and tiredness are common. The catheter keeps the bladder empty.
- Weeks 2 to 3The cystogram
An X-ray checks the repair. If it is sealed, the catheter is removed.
- Weeks 3 to 6Dry again
Most women are dry from the vagina. Urgency and frequency are common at first and settle.
- 6 to 12 weeksCheck-up
An exam confirms healing. Your surgeon tells you when it is safe to resume sex.
- 3 monthsIf the leak returns
If a leak persists, it is investigated, and a second repair is usually planned after the tissues have healed.
- Long termMoving on
Most women stay dry for good. Any other bladder symptoms can be treated separately.
What it feels like
Living with a fistula is hard. Many women describe constant wetness, worry about odor, sore skin, and pulling away from friends, work, and intimacy. The repair brings real hope, and also fear that it will not work. The weeks with the catheter can feel long, because you are waiting to find out.
Being told what it is
Relief at finally having a name for it. Some women also feel anger, especially if it followed an operation.
What helpsAsk every question you have, and consider talking with a counselor. These feelings are normal.
The weeks before surgery
Constant pad changes, sore skin, and staying close to home.
What helpsBarrier creams, high-absorbency products, and changing often protect your skin.
Waking up
Pressure from the packing, a catheter, and an anxious wait to see whether you are dry.
What helpsEarly dryness is encouraging, but the real test comes when the catheter is out.
Bladder spasms
Sudden painful cramps and leaking around the catheter, which can be frightening.
What helpsLeaking around the catheter during a spasm is common and does not mean the repair failed. Take the spasm medicine.
The catheter weeks
Constant checking of the tubing and worry about kinks.
What helpsA routine helps: check the tubing each time you stand up, and empty the bag on a schedule.
The day the catheter comes out
For many, being dry for the first time in months brings tears of relief.
What helpsSome urgency or small leaks with urges are common early on and are different from a fistula leak.
Getting back to normal life
Confidence returns slowly. Intimacy can feel daunting.
What helpsWait until you are cleared, use plenty of lubricant, and go slowly. Talk with your surgeon about any pain.
How well it works
Success means staying dry from the vagina after the catheter comes out. Most women are dry after the first repair. Repairs after radiation, very large fistulas, and repeat repairs have lower success rates, but a second repair often works when the first does not.
- Cystogram
An X-ray with dye before catheter removal shows that the repair is sealed.
- Dye test at follow-up
If there is any doubt, colored fluid is placed in the bladder to check for a leak.
- Other bladder symptoms
Urgency or leaking with coughing can appear after repair and can be treated separately.
- Kidney check
If a ureter was involved, imaging confirms the kidney drains well.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Cramps and leaking around the catheter while it is in.
Common in the first days.
Normal for a few weeks as the stitches dissolve.
Less common
The repair does not hold and urine leaks again. A second repair is often successful.
Burning, fever, or cloudy urine. Treated with antibiotics.
New bladder symptoms after the repair. They often improve with time or treatment.
More likely with some vaginal techniques. Ask your surgeon how your repair may affect vaginal length.
Rare
May need a stent or a repair.
With a belly approach. Usually recognized and repaired during surgery.
Uncommon.
Prevented with walking, leg sleeves, and sometimes blood-thinning injections.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- The catheter stops draining for more than 1 hour, or falls out (do not reinsert it; call right away)
- Severe or worsening belly pain, or a swollen belly
- Heavy vaginal bleeding (soaking a pad every hour) or large clots
- Pain in your side or back with fever
- After the catheter is out: a constant watery leak from the vagina again
- Leg swelling or pain, chest pain, or shortness of breath (call 911 for chest pain or trouble breathing)
Questions to ask your surgeon
- Where exactly is my fistula, and how large is it?
- Is a ureter involved?
- Do you recommend a vaginal or a belly approach for me, and why?
- When is the best time to repair it?
- Could I try a catheter first to see if it heals on its own?
- Will you use a tissue flap, and which one?
- How long will I have a catheter?
- What is my chance of success, given my history?
- How many fistula repairs do you do each year?
- Do I need a biopsy first?
- When can I have sex again, and will the repair change my vagina?
Words you may hear
- Fistula
- An abnormal tunnel between two organs.
- Vesicovaginal
- Between the bladder (vesico) and the vagina.
- Vaginal cuff
- The closed top of the vagina after a hysterectomy.
- Ureter
- The tube that carries urine from a kidney to the bladder.
- Ureteral catheter
- A thin temporary tube passed up a ureter to find and protect it during surgery.
- Dye test
- Filling the bladder with colored fluid to see where urine leaks.
- Cystoscopy
- Looking inside the bladder with a thin camera.
- Cystogram
- An X-ray of the bladder filled with dye, used to check for leaks.
- Martius flap
- A pad of fatty tissue from the outer lip of the vagina used to cushion a repair.
- Omentum
- A fatty apron of tissue inside the belly with a good blood supply, used as a flap.
- Peritoneum
- The thin lining of the inside of the belly.
- Latzko repair
- A vaginal technique that closes the top of the vagina over the fistula.
- Obstetric fistula
- A fistula caused by prolonged, blocked labor.
Common questions
Did my surgeon do something wrong?
A fistula is a known complication of pelvic surgery and can happen even when an operation is done carefully. Your repair surgeon can review what happened with you.
Can it heal on its own?
A small, fresh fistula sometimes heals with a catheter kept in for several weeks. Once a fistula is mature, it rarely closes without surgery.
Why do I have to wait for surgery?
Some fistulas can be repaired early. Others are repaired after inflammation settles, which gives the best chance of success. After radiation, surgeons often wait longer.
Will I be able to have sex again?
Most women can, once they are fully healed and cleared, usually after 6 to 12 weeks. Some techniques can shorten the vagina, so ask your surgeon how your repair may affect this.
Is the fistula a sign of cancer?
Usually not. After radiation or cancer treatment, a biopsy is often taken to make sure.
What if the repair fails?
A second repair, often after waiting a few months, succeeds for many women. Experienced fistula surgeons can offer several options.
Sources this page draws on
- International Consultation on Incontinence, Incontinence (committee report on fistula)
- World Health Organization, Obstetric fistula: guiding principles for clinical management and programme development (2006)
- International Federation of Gynecology and Obstetrics (FIGO), Global Competency-Based Fistula Surgery Training Manual
- Campbell-Walsh-Wein Urology, Campbell-Walsh-Wein Urology, 12th edition (chapter on urinary tract fistulas) (2020)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.