The classic presentation of a vesicovaginal
fistula is continuous (day and night) incontinence following a recent pelvic
operation such as a vaginal hysterectomy. However, a watery vaginal discharge
accompanied by normal voiding may be the only symptom. Perineal dermatitis may
result from long-term exposure to urine. Typically, vesicovaginal fistulas are
clinically evident within 10 days of the injury. Cystoscopy and upper urinary
tract evaluation should be completed in every patient with a urinary fistula.
