A woman infected with Schistosoma haematobium may develop a vesicovaginal fistula.
Risk factors:
(1) heavy worm burden
(2) marked inflammation
(3) poor wound healing
Criteria for the diagnosis of vesico-vaginal fistula due to Schistosomiasis:
(1) residence or visit to an endemic region for Schistosoma haematobium
(2) evidence of schistosomiasis (biopsy, serology, PCR, etc)
(3) exclusion of other causes of fistula (see below)
(4) clinical improvement with management that includes antischistosomal therapy
Conditions which can cause a vesicovaginal fistula includes:
(1) obstetric trauma
(2) penetrating pelvic trauma, including genital mutilation
(3) tuberculosis
(4) other pelvic infections
(5) genital surgery
(6) radiation therapy
(7) cancer
If schistosomiasis is the cause of the fistula then it is important to treat the schistosomiasis before attempting surgical closure of the fistula tract.
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