Surgical repair of VVF, through vaginal or abdominal route, is the only definitive treatment with the success rates of as high as 85% to 95%5. Unfortunately, even after successful closure of VVF normal bladder function is not regained in a significant number of patients. It is estimated that rate of stress urinary incontinence remains as high as 33% to 55% after successful repair after treating VVF it was found that detrusor instability was present in 50% cases and 11% found to have residual stress urinary incontinence. Other important reported complications after VVF repair include vaginal stenosis with dyspareunia, persistent amenorrhea and reduced bladder capacity. 

Objective : To determine the functional outcome of the urinary bladder after successful surgical closure of VVF.

All those patients with VVF who underwent successful surgical repair of VVF (abdominal as well as vaginal) for the 1st time were inducted in the study. Patients with the history of previous VVF repair, previous bladder surgery, bladder trauma and neurogenic bladder were excluded. In total of 96 patients were examined with standard urodynamic studies. Studies were done 4 to 12 weeks after surgical repair. All the surgeries were performed by a single surgeon with a special interest and > 15 year experience in VVF surgeries.
 Causes of VVF, time between formation & repair of fistula, bladder capacity, detrusor pressure and any stress or urge incontinence were noted.

Mean age of patients were 32 [15-72] yrs. 31 cases were of obstructed labor, while remaining were of iatrogenic causes. There was reduction in bladder capacity in all cases but more prevalent in those patients who had vvf for more than 1 year. Around 28% of patient had stress leakage more prevalent in obstructed labor cases. While there was detrusor instability with involuntary contractions in around 50 % of cases increasing with duration of fistula present. Nearly all those leaking had longer duration of fistula and catheterization.

Though in most of the cases fistula repair is successful but continence is not restored in around 20 % of cases as a consequence of damage to pelvic musculature due to ischemia due to obstructed labour. Also changes that take place in bladder because of presence of fistula. Damage is directly proportional to the duration of fistula with decrease in bladder capacity and increase in involuntary bladder contractions.

Though vvf can be repaired in most of the cases, but consequences remains in forms of reduced capacity and stress and urge incontinence.