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A vesicovaginal fistula is an abnormal communication between the bladder and the vagina. Because a tract connects the bladder directly to the vaginal canal, urine can drain into the vagina continuously, leading to persistent leakage regardless of voluntary urination. This is what distinguishes it from other pelvic issues.

A cystocele, by contrast, is a downward protrusion of the bladder into the vaginal wall without a connecting tract; it can cause incontinence or pelvic pressure but not a constant urine stream through the vagina. Cystalgia refers to bladder pain, not a fistulous connection. Pyelitis is an infection of the kidney’s pelvis and calyces, which does not create a vaginal drainage pathway. The constant urinary leakage described is characteristic of a vesicovaginal fistula.