Ureterovaginal fistula

Ureterovaginal Fistula

Illustration from a 1910 gynecological diagnosis book showing the anatomy relevant to ureterovaginal fistulas.

A ureterovaginal fistula is an abnormal connection between the ureter and the vagina. This condition can lead to continuous urinary incontinence, as urine bypasses the bladder and flows directly into the vagina.

Causes

Ureterovaginal fistulas are often a complication of surgical procedures, particularly those involving the pelvic region. Common causes include:

• Gynecological surgery: Procedures such as hysterectomy or pelvic lymphadenectomy can inadvertently damage the ureter.
• Obstetric trauma: Difficult childbirth or cesarean sections may result in fistula formation.
• Radiation therapy: Treatment for pelvic cancers can lead to tissue damage and fistula development.
• Infections: Severe infections in the pelvic area can erode tissue and create fistulas.

Symptoms

The primary symptom of a ureterovaginal fistula is continuous leakage of urine from the vagina. Other symptoms may include:

• Urinary incontinence: Inability to control urine flow.
• Vaginal discharge: Persistent watery discharge.
• Recurrent urinary tract infections: Due to the abnormal flow of urine.

Diagnosis

Diagnosis of a ureterovaginal fistula typically involves:

• Medical history and physical examination: Initial assessment by a healthcare provider.
• Imaging studies: Techniques such as intravenous pyelogram (IVP) or CT urography to visualize the urinary tract.
• Cystoscopy: Endoscopic examination of the bladder and urethra.
• Vaginal dye test: Introduction of a dye into the bladder to check for leakage into the vagina.

Treatment

Treatment options for ureterovaginal fistulas include:

• Surgical repair: The most common treatment, involving the closure of the fistula and restoration of normal anatomy.
• Ureteral stenting: Temporary placement of a stent to allow healing.
• Nephrostomy: Diversion of urine through a tube inserted into the kidney, used in severe cases.

Prognosis

With appropriate surgical intervention, the prognosis for patients with ureterovaginal fistulas is generally good. Most patients regain normal urinary function and experience relief from symptoms.

Related Pages

• Urinary incontinence
• Fistula
• Hysterectomy

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