Urovaginal Fistula

2.
1 Urovagina Fistula
A fistula is defined as an abnormal communication between 2 or more epithelial
surfaces. Urovaginal fistula is a devastating condition in which an abnormal
channel is created between the vagina and the urinary tract. Most frequently it
involves bladder, but sometimes to the urethra or to the ureter. It results in
continuous leakage of urine from the vagina, which for most women is a major
personal and social problems.
For countries in the industrialized world, gynecological surgery is the most
common cause of urovaginal fistulae development with hysterectomy as the leading
cause of this complications, followed by complicated obstructive labor. The
incidence of urovaginal fistula formation is lower in the well-developed countries.
2.2 Vesicovaginal Fistula
Vesicovaginal fistula is an abnormal communication between bladder and
vagina. This is the most common urovaginal fistula.
2.2.1 Etiology of Vesicovaginal Fistula
There are some causes of vesicovaginal fistula, such as congenital, trauma,
inflammatory disease, malignant neoplasm, and radium necrosis. Obstetric trauma
(necrotic and traumatic obstetric fistula) is the most common cause of vesicovaginal
fistula due to trauma, followed by surgical trauma and direct trauma.
Prolonged and obstructed labour may result in necrotic obstetric fistula.
Prolonged compression of soft tissues between head and brim of a narrow pelvis
causes pressure, ischemia, necrosis, and sloughing of the base of bladder. Slough
takes some days to separate. Incontinence develops 5-7 days after labour. This type
of fistula are often surrounded by dense fibrosis. Traumatic obstetric fistula is
caused by direct injury to the bladder wall by sharp instrument (perforator or
decapitation hook) during a difficult labour. Incontinence usually appears
immediately after labour. Traumatic fistula due to surgical trauma usually occurs
during vaginal operation (such as anterior colporrhaphy) or during abdominal
operation (such as hysterectomy). Direct trauma is a rare cause.
Vesicovaginal fistula due to inflammatory disease results from bilharziasis of
bladder, tuberculosis, and pelvic abscess. Malignant neoplasms (carcinoma of
cervix, bladder, or vagina) may invade directly and create fistula. Radium treatment
used for malignant disease in pelvis cause sloughing of bladder.
2.2.2 Symptoms of Vesicovaginal Fistula
Patients with vesicovaginal fistula usually come to the hospital with urinary
incontinence as the main symptoms. Patients complain about continuous dribbling
of urine and may be accompanied with vulvitis (pruritus, burning pain due to
continuous discharge of urine) and cystitis (due to ascending infection from vulva).
The symptoms may affect the quality of life and patients self confidence.
2.2.3 Diagnosis of Vesicovaginal Fistula
History taking may revealed the history of incontinence following labour or
operation. Large fistula can be palpated during palpation of anterior vaginal wall.
Small fistula is usually surrounded by fibrotic tissue. Inspection of the anterior

vaginal wall is performed using Sims speculum in Sims position or left lateral
(semi-prone) position.
For small and high fistula, dye test may be helpful. Methylene blue is injected
into the bladder using a catheter to ourline the fistula while anterior vaginal wall is
inspected by use of Sims speculum. Sometimes a metal catheter or sound is passed
through the urethra to appear at the fistulous opening. Fistulography gives the clear
image of vesicovaginal fistula.
2.2.4 Management of Vesicovaginal Fistula
Vesicovaginal fistula due to gynecologic or obstetric procedures can be
prevented by proper antenatal screening (contracted pelvis, malpresentations). If
injury to the bladder is discovered during difficult labour, do not suture the tear due
to tissue edema and friability. Insertion and fixation of rubber catheter through
urethra for 10 days will help the tear to heal completely or be smaller. If the injury
is detected some times after labour, surgical repair should be performed at least 3
months after delivery to allow for maximum involution to the tissues. Other
complications should be treated prior to reconstruction procedure. Cystoscopy is
performed to determine the relation of the fistula to the ureteric openings in the
bladder, exclude multiple fistulas, and reveal associated bladder pathology.
2.3 Uretero-vaginal Fistula
Vesicovaginal fistula is an abnormal communication between ureter and vagina.
2.3.1 Etiology of Uretero-vaginal Fistula
Uretero-vaginal fistula may occurs following the injury to ureter during a
gynecological procedure (such as hysterectomy) or difficult labor.

2.3.2 Symptoms of Uretero-vaginal Fistula
The main symptom of uretero-vaginal fistula is incomplete incontinence. Urine
from affected ureter escapes from vagina while bladder fills up and empties
normally from other ureter. The fistula is always small and high up in vagina lateral
to cervix.
2.2.3 Diagnosis of Uretero-vaginal Fistula
Uretero-vaginal fistula is differentiated from a vesico-vaginal fistula by
methylene blue test and cystoscopy (shows ureteric efflux on one side only).
2.2.4 Management of Uretero-vaginal Fistula
Uretero-vaginal fistula can be avoided by pre-operative intravenous
pyelography, ureteric catheterization, and proper surgical technique. The surgical
intervention for uretero-vaginal fistula are abdominal re-implantation of ureter into
bladder or sigmoid colon (if not possible into the bladder). If the kidney function is
very poor on the affected side, the kidney can be sacrified.

Urovaginal Fistula

Uploaded by

Copyright:

Available Formats

Urovaginal Fistula

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Urovaginal Fistula

Uploaded by

Copyright:

Available Formats

2.

A fistula is defined as an abnormal communication between 2 or more epithelial

surfaces. Urovaginal fistula is a devastating condition in which an abnormal

involves bladder, but sometimes to the urethra or to the ureter. It results in

personal and social problems.

For countries in the industrialized world, gynecological surgery is the most

common cause of urovaginal fistulae development with hysterectomy as the leading

cause of this complications, followed by complicated obstructive labor. The

incidence of urovaginal fistula formation is lower in the well-developed countries.

2.2 Vesicovaginal Fistula

Vesicovaginal fistula is an abnormal communication between bladder and

vagina. This is the most common urovaginal fistula.

2.2.1 Etiology of Vesicovaginal Fistula

There are some causes of vesicovaginal fistula, such as congenital, trauma,

inflammatory disease, malignant neoplasm, and radium necrosis. Obstetric trauma

fistula due to trauma, followed by surgical trauma and direct trauma.

Prolonged and obstructed labour may result in necrotic obstetric fistula.

of fistula are often surrounded by dense fibrosis. Traumatic obstetric fistula is

caused by direct injury to the bladder wall by sharp instrument (perforator or

decapitation hook) during a difficult labour. Incontinence usually appears

during vaginal operation (such as anterior colporrhaphy) or during abdominal

operation (such as hysterectomy). Direct trauma is a rare cause.

Vesicovaginal fistula due to inflammatory disease results from bilharziasis of

bladder, tuberculosis, and pelvic abscess. Malignant neoplasms (carcinoma of

used for malignant disease in pelvis cause sloughing of bladder.

2.2.2 Symptoms of Vesicovaginal Fistula

incontinence as the main symptoms. Patients complain about continuous dribbling

2.2.3 Diagnosis of Vesicovaginal Fistula

History taking may revealed the history of incontinence following labour or

Small fistula is usually surrounded by fibrotic tissue. Inspection of the anterior

inspected by use of Sims speculum. Sometimes a metal catheter or sound is passed

image of vesicovaginal fistula.

2.2.4 Management of Vesicovaginal Fistula

Vesicovaginal fistula due to gynecologic or obstetric procedures can be

prevented by proper antenatal screening (contracted pelvis, malpresentations). If

complications should be treated prior to reconstruction procedure. Cystoscopy is

bladder, exclude multiple fistulas, and reveal associated bladder pathology.

2.3 Uretero-vaginal Fistula

Vesicovaginal fistula is an abnormal communication between ureter and vagina.

2.3.1 Etiology of Uretero-vaginal Fistula

Uretero-vaginal fistula may occurs following the injury to ureter during a

gynecological procedure (such as hysterectomy) or difficult labor.

The main symptom of uretero-vaginal fistula is incomplete incontinence. Urine

2.2.3 Diagnosis of Uretero-vaginal Fistula

Uretero-vaginal fistula is differentiated from a vesico-vaginal fistula by

2.2.4 Management of Uretero-vaginal Fistula

Uretero-vaginal fistula can be avoided by pre-operative intravenous

pyelography, ureteric catheterization, and proper surgical technique. The surgical

intervention for uretero-vaginal fistula are abdominal re-implantation of ureter into

very poor on the affected side, the kidney can be sacrified.

You might also like