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Urinary Tract Fistula

  • Brett D. Lebed
  • Eric S. Rovner
Chapter
Part of the Springer Specialist Surgery Series book series (SPECIALIST)

Abstract

A fistula is defined as an extra-anatomic communication between two or more epithelial or mesothelial lined body cavities or the skin surface. Fistula can occur as a result of congenital anomalies, malignancy, inflammation or infection, tissue trauma, or iatrogenic causes, such as surgical injury or radiation. There have been reports of fistula formation since ancient times, involving connections from the urinary tract to a myriad of bodily cavities and organs. Organ systems immediately adjacent to the urinary tract are the most commonly affected, specifically the reproductive, gastrointestinal, and vascular systems. Presenting signs and symptoms of urinary fistula are dependent on the termination point of the fistula, the fistula size, concomitant infection or inflammatory processes, and associated malignancy or other medical conditions.

Keywords

Fistula Tract Anterior Vaginal Wall Vaginal Cuff Vesicovaginal Fistula Obstetric Fistula 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gerber GS, Schoenberg HW. Female urinary tract fistulas. J Urol. 1993;149:229-236PubMedGoogle Scholar
  2. 2.
    Sims J. On the treatment of vesicovaginal fistula. Am J Med Sci. 1852;23:59CrossRefGoogle Scholar
  3. 3.
    Trendelenburg F. Discussion zu Halferich Zuganglichmachung der Vorderen Blasenwand. Dtsch Ges Chir. 1888;17:101Google Scholar
  4. 4.
    Symmonds RE. Incontinence: vesical and urethral fistulas. Clin Obstet Gynecol. 1984;27:499-514PubMedCrossRefGoogle Scholar
  5. 5.
    Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet. 1992;175:501-506PubMedGoogle Scholar
  6. 6.
    Armenakas NA, Pareek G, Fracchia JA. Iatrogenic bladder perforations: longterm followup of 65 patients. J Am Coll Surg. 2004;198:78-82PubMedCrossRefGoogle Scholar
  7. 7.
    Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169:1033-1036PubMedCrossRefGoogle Scholar
  8. 8.
    Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv. 1995;50:795-805PubMedCrossRefGoogle Scholar
  9. 9.
    Keettel WC, Sehring FG, de Prosse CA, Scott JR. Surgical management of urethrovaginal and vesicovaginal fistulas. Am J Obstet Gynecol. 1978;131:425-431PubMedGoogle Scholar
  10. 10.
    Kursh ED, Morse RM, Resnick MI, Persky L. Prevention of the development of a vesicovaginal fistula. Surg Gynecol Obstet. 1988;166:409-412PubMedGoogle Scholar
  11. 11.
    Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol. 1991;146:761-765PubMedGoogle Scholar
  12. 12.
    Alert J, Jimenez J, Beldarrain L, Montalvo J, Roca C. Complications from irradiation of carcinoma of the uterine cervix. Acta Radiol Oncol. 1980;19:13-15PubMedCrossRefGoogle Scholar
  13. 13.
    Zoubek J, McGuire EJ, Noll F, DeLancey JO. The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma. J Urol. 1989;141:1347-1349PubMedGoogle Scholar
  14. 14.
    Rovner E. Vesicovaginal and urethrovaginal fistulas. AUA Update Ser. 2006;25:45-55Google Scholar
  15. 15.
    Danso KA, Martey JO, Wall LL, Elkins TE. The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977–1992. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7:117-120PubMedCrossRefGoogle Scholar
  16. 16.
    Margolis T, Elkins TE, Seffah J, Oparo-Addo HS, Fort D. Full-thickness Martius grafts to preserve vaginal depth as an adjunct in the repair of large obstetric fistulas. Obstet Gynecol. 1994;84:148-152PubMedGoogle Scholar
  17. 17.
    Margolis T, Mercer LJ. Vesicovaginal fistula. Obstet Gynecol Surv. 1994;49:840-847PubMedCrossRefGoogle Scholar
  18. 18.
    Arrowsmith SD. Genitourinary reconstruction in obstetric fistulas. J Urol. 1994;152:403-406PubMedGoogle Scholar
  19. 19.
    Drutz HP, Mainprize TC. Unrecognized small vesicovaginal fistula as a cause of persistent urinary incontinence. Am J Obstet Gynecol. 1988;158:237-240PubMedGoogle Scholar
  20. 20.
    Moir JC. Vesico-vaginal fistulae as seen in Britain. J Obstet Gynaecol Br Commonw. 1973;80:598-602PubMedCrossRefGoogle Scholar
  21. 21.
    Raghavaiah NV. Double-dye test to diagnose various types of vaginal fistulas. J Urol. 1974;112:811-812PubMedGoogle Scholar
  22. 22.
    Goodwin WE, Scardino PT. Vesicovaginal and ureterovaginal fistulas: a summary of 25 years of experience. J Urol. 1980;123:370-374PubMedGoogle Scholar
  23. 23.
    Kuhlman JE, Fishman EK. CT evaluation of enterovaginal and vesicovaginal fistulas. J Comput Assist Tomogr. 1990;14:390-394PubMedCrossRefGoogle Scholar
  24. 24.
    Davits RJ, Miranda SI. Conservative treatment of vesicovaginal fistulas by bladder drainage alone. Br J Urol. 1991;68:155-156PubMedCrossRefGoogle Scholar
  25. 25.
    Stovsky MD, Ignatoff JM, Blum MD, Nanninga JB, O’Conor VJ, Kursh ED. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152:1443-1444PubMedGoogle Scholar
  26. 26.
    Pettersson S, Hedelin H, Jansson I, Teger-Nilsson AC. Fibrin occlusion of a vesicovaginal fistula. Lancet. 1979;1:933PubMedCrossRefGoogle Scholar
  27. 27.
    Badenoch DF, Tiptaft RC, Thakar DR, Fowler CG, Blandy JP. Early repair of accidental injury to the ureter or bladder following gynaecological surgery. Br J Urol. 1987;59:516-518PubMedCrossRefGoogle Scholar
  28. 28.
    Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153:1110-1112; discussion 1112-1113PubMedCrossRefGoogle Scholar
  29. 29.
    Collins CG, Collins JH, Harrison BR, Nicholls RA, Hoffman ES, Krupp PJ. Early repair of vesicovaginal fistula. Am J Obstet Gynecol. 1971;111:524-528PubMedGoogle Scholar
  30. 30.
    Cruikshank SH. Early closure of posthysterectomy vesicovaginal fistulas. South Med J. 1988;81:1525-1528PubMedCrossRefGoogle Scholar
  31. 31.
    Kostakopoulos A, Deliveliotis C, Louras G, Giftopoulos A, Skolaricos A. Early repair of injury to the ureter or bladder after hysterectomy. Int Urol Nephrol. 1998;30:445-450PubMedCrossRefGoogle Scholar
  32. 32.
    Persky L, Herman G, Guerrier K. Nondelay in vesicovaginal fistula repair. Urology. 1979;13:273-275PubMedCrossRefGoogle Scholar
  33. 33.
    Wang Y, Hadley HR. Nondelayed transvaginal repair of high lying vesicovaginal fistula. J Urol. 1990;144:34-36PubMedGoogle Scholar
  34. 34.
    Waaldijk K. The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. Int J Gynaecol Obstet. 1994;45:11-16PubMedCrossRefGoogle Scholar
  35. 35.
    Wein AJ, Malloy TR, Carpiniello VL, Greenberg SH, Murphy JJ. Repair of vesicovaginal fistula by a suprapubic transvesical approach. Surg Gynecol Obstet. 1980;150:57-60PubMedGoogle Scholar
  36. 36.
    Tancer ML. The post-total hysterectomy (vault) vesicovaginal fistula. J Urol. 1980;123:839-840PubMedGoogle Scholar
  37. 37.
    Motiwala HG, Amlani JC, Desai KD, Shah KN, Patel PC. Transvesical vesicovaginal fistula repair: a revival. Eur Urol. 1991;19:24-28PubMedGoogle Scholar
  38. 38.
    Rovner E. Urinary tract fistula. In: Wein AJ, ed. Campbell-Walsh Urology, vol. 3. Philadelphia: W.B. Saunders; 2007:2322-2360Google Scholar
  39. 39.
    O’Conor VJ Jr. Review of experience with vesicovaginal fistula repair. J Urol. 1980;123:367-369PubMedGoogle Scholar
  40. 40.
    Gil-Vernet JM, Gil-Vernet A, Campos JA. New surgical approach for treatment of complex vesicovaginal fistula. J Urol. 1989;141:513-516PubMedGoogle Scholar
  41. 41.
    Raz S, Bregg KJ, Nitti VW, Sussman E. Transvaginal repair of vesicovaginal fistula using a peritoneal flap. J Urol. 1993;150:56-59PubMedGoogle Scholar
  42. 42.
    Zimmern PE, Hadley HR, Staskin DR, Raz S. Genitourinary fistulae. Vaginal approach for repair of vesicovaginal fistulae. Urol Clin North Am. 1985;12:361-367PubMedGoogle Scholar
  43. 43.
    Blaivas JG. Vaginal flap urethral reconstruction: an alternative to the bladder flap neourethra. J Urol. 1989;141:542-545PubMedGoogle Scholar
  44. 44.
    Glavind K, Larsen EH. Results and complications of tension-free vaginal tape (TVT) for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:370-372PubMedCrossRefGoogle Scholar
  45. 45.
    Henriksson C, Kihl B, Pettersson S. Urethrovaginal and vesicovaginal fistula. A review of 29 patients. Acta Obstet Gynecol Scand. 1982;61:143-148PubMedCrossRefGoogle Scholar
  46. 46.
    Webster GD, Sihelnik SA, Stone AR. Urethrovaginal fistula: a review of the surgical management. J Urol. 1984;132:460-462PubMedGoogle Scholar
  47. 47.
    Elkins TE. Surgery for the obstetric vesicovaginal fistula: a review of 100 operations in 82 patients. Am J Obstet Gynecol. 1994;170:1108-1118; discussion 1118-1120PubMedGoogle Scholar
  48. 48.
    Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72:313-319PubMedGoogle Scholar
  49. 49.
    Leach GE. Urethrovaginal fistula repair with Martius labial fat pad graft. Urol Clin North Am. 1991;18:409-413PubMedGoogle Scholar
  50. 50.
    Tehan TJ, Nardi JA, Baker R. Complications associated with surgical repair of urethrovaginal fistula. Urology. 1980;15:31-35PubMedCrossRefGoogle Scholar
  51. 51.
    Wang Y, Hadley HR. The use of rotated vascularized pedicle flaps for complex transvaginal procedures. J Urol. 1993;149:590-592PubMedGoogle Scholar
  52. 52.
    Birkhoff JD, Wechsler M, Romas NA. Urinary fistulas: vaginal repair using a labial fat pad. J Urol. 1977;117:595-597PubMedGoogle Scholar
  53. 53.
    Bruce RG, El-Galley RE, Galloway NT. Use of rectus abdominis muscle flap for the treatment of complex and refractory urethrovaginal fistulas. J Urol. 2000;163:1212-1215PubMedCrossRefGoogle Scholar
  54. 54.
    Davis RS, Linke CA, Kraemer GK. Use of labial tissue in repair of urethrovaginal fistula and injury. Arch Surg. 1980;115:628-630PubMedGoogle Scholar
  55. 55.
    Fall M. Vaginal wall bipedicled flap and other techniques in complicated urethral diverticulum and urethrovaginal fistula. J Am Coll Surg. 1995;180:150-156PubMedGoogle Scholar
  56. 56.
    Patil U, Waterhouse K, Laungani G. Management of 18 difficult vesicovaginal and urethrovaginal fistulas with modified Ingelman-Sundberg and Martius operations. J Urol. 1980;123:653-656PubMedGoogle Scholar
  57. 57.
    Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the martius procedure in the management of urinary-vaginal fistulas. J Am Coll Surg. 2000;191:259-263PubMedCrossRefGoogle Scholar
  58. 58.
    Candiani P, Austoni E, Campiglio GL, Ceresoli A, Zanetti G, Colombo F. Repair of a recurrent urethrovaginal fistula with an island bulbocavernous musculocutaneous flap. Plast Reconstr Surg. 1993;92:1393-1396PubMedGoogle Scholar
  59. 59.
    Krogh J, Kay L, Hjortrup A. Treatment of urethrovaginal fistula. Br J Urol. 1989;63:555PubMedCrossRefGoogle Scholar
  60. 60.
    McKinney DE. Use of full thickness patch graft in urethrovaginal fistula. J Urol. 1979;122:416PubMedGoogle Scholar
  61. 61.
    Tolle E, Schmandt W, Beizai S, Drepper H. Closure of large vesico – urethra – vaginal defect with pedicled myocutaneous gracilis flap (author’s transl). Urologe A. 1981;20:274-7PubMedGoogle Scholar
  62. 62.
    Lamensdorf H, Compere DE, Begley GF. Simple surgical correction of urethrovaginal fistula. Urology. 1977;10:152-153PubMedCrossRefGoogle Scholar
  63. 63.
    Billmeyer BR, Nygaard IE, Kreder KJ. Ureterouterine and vesicoureterovaginal fistulas as a complication of cesarean section. J Urol. 2001;165:1212-1213PubMedCrossRefGoogle Scholar
  64. 64.
    Symmonds RE. Ureteral injuries associated with gynecologic surgery: prevention and management. Clin Obstet Gynecol. 1976;19:623-644PubMedCrossRefGoogle Scholar
  65. 65.
    Payne C. Ureteral injuries in the female: fistulas and obstruction. In: Raz S, ed. Female Urology. Philadelphia: W.B. Saunders; 1996:507-520Google Scholar
  66. 66.
    Mandal AK, Sharma SK, Vaidyanathan S, Goswami AK. Ureterovaginal fistula: summary of 18 years’ experience. Br J Urol. 1990;65:453-456PubMedCrossRefGoogle Scholar
  67. 67.
    Harkki-Siren P, Sjoberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;92:113-118PubMedCrossRefGoogle Scholar
  68. 68.
    Selzman AA, Spirnak JP, Kursh ED. The changing management of ureterovaginal fistulas. J Urol. 1995;153:626-628PubMedCrossRefGoogle Scholar
  69. 69.
    Dowling RA, Corriere JN Jr, Sandler CM. Iatrogenic ureteral injury. J Urol. 1986;135:912-915PubMedGoogle Scholar
  70. 70.
    Tancer ML. Vesicouterine fistula – a review. Obstet Gynecol Surv. 1986;41:743-753PubMedCrossRefGoogle Scholar
  71. 71.
    Jozwik M, Jozwik M, Lotocki W. Vesicouterine fistula – an analysis of 24 cases from Poland. Int J Gynaecol Obstet. 1997;57:169-172PubMedCrossRefGoogle Scholar
  72. 72.
    Futter NG, Baker K. A vesicouterine fistula caused by catheterization during delivery. Can J Urol. 1995;2:107-108PubMedGoogle Scholar
  73. 73.
    Gil A, Sultana CJ. Vesicouterine fistula after vacuum delivery and two previous cesarean sections. A case report. J Reprod Med. 2001;46:853-855PubMedGoogle Scholar
  74. 74.
    Krysiewicz S, Auh YH, Kazam E. Vesicouterine fistula associated with placenta percreta. Urol Radiol. 1988;10:213-215PubMedCrossRefGoogle Scholar
  75. 75.
    Memon MA, Zieg DA, Neal PM. Vesicouterine fistula twenty years following brachytherapy for cervical cancer. Scand J Urol Nephrol. 1998;32:293-295PubMedCrossRefGoogle Scholar
  76. 76.
    Graziotti P, Lembo A, Artibani W. Spontaneous closure of vesicouterine fistula after cesarean section. J Urol. 1978;120:372PubMedGoogle Scholar
  77. 77.
    Jozwik M, Jozwik M. Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment. Urol Int. 1999;62:183-187PubMedCrossRefGoogle Scholar
  78. 78.
    Novi JM, Rose M, Shaunik A, Ramchandani P, Morgan MA. Conservative management of vesicouterine fistula after uterine rupture. Int Urogynecol J Pelvic Floor Dysfunct. 2004;15:434-435PubMedCrossRefGoogle Scholar
  79. 79.
    Hafner CD PJ, Brush BE. Genitourinary manifestations of diverticulitis of the colon. J Am Med Assoc. 1962;179:76Google Scholar
  80. 80.
    Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 2004;188:617-621PubMedCrossRefGoogle Scholar
  81. 81.
    Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL. One-stage resection and anastomosis in the management of colovesical fistula. Am J Surg. 1987;153:75-79PubMedCrossRefGoogle Scholar
  82. 82.
    Gruner JS, Sehon JK, Johnson LW. Diagnosis and management of enterovesical fistulas in patients with Crohn’s disease. Am Surg. 2002;68:714-719PubMedGoogle Scholar
  83. 83.
    Solem CA, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Sandborn WJ. Fistulas to the urinary system in Crohn’s disease: clinical features and outcomes. Am J Gastroenterol. 2002;97:2300-2305PubMedCrossRefGoogle Scholar
  84. 84.
    Rao PN, Knox R, Barnard RJ, Schofield PF. Management of colovesical fistula. Br J Surg. 1987;74:362-363PubMedCrossRefGoogle Scholar
  85. 85.
    Morse FP 3rd, Dretler SP. Diagnosis and treatment of colovesical fistula. J Urol. 1974;111:22-24PubMedGoogle Scholar
  86. 86.
    Labs JD, Sarr MG, Fishman EK, Siegelman SS, Cameron JL. Complications of acute diverticulitis of the colon: improved early diagnosis with computerized tomography. Am J Surg. 1988;155:331-336PubMedCrossRefGoogle Scholar
  87. 87.
    Geier GR Jr, Ujiki G, Shields TW. Colovesical fistula. Arch Surg. 1972;105:347-351PubMedGoogle Scholar
  88. 88.
    Dudrick SJ, Maharaj AR, McKelvey AA. Artificial nutritional support in patients with gastrointestinal fistulas. World J Surg. 1999;23:570-576PubMedCrossRefGoogle Scholar
  89. 89.
    McConnell DB, Sasaki TM, Vetto RM. Experience with colovesical fistula. Am J Surg. 1980;140:80-84PubMedCrossRefGoogle Scholar
  90. 90.
    Desmond JM, Evans SE, Couch A, Morewood DJ. Pyeloduodenal fistulae. A report of two cases and review of the literature. Clin Radiol. 1989;40:267-270PubMedCrossRefGoogle Scholar
  91. 91.
    Majeed HA, Mohammed KA, Salman HA. Renocolic fistula as a complication to xanthogranulomatous pyelonephritis. Singapore Med J. 1997;38:116-119PubMedGoogle Scholar
  92. 92.
    Yildiz M, Atan A, Aydoganli L, Cengiz T, Akalin Z. Renocolic fistula secondary to chronic pyelonephritis. Int Urol Nephrol. 1993;25:229-233PubMedGoogle Scholar
  93. 93.
    LeRoy AJ, Williams HJ Jr, Bender CE, Segura JW, Patterson DE, Benson RC. Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology. 1985;155:83-85PubMedGoogle Scholar
  94. 94.
    Vanderbrink BA, Rastinehad A, Caplin D, Ost MC, Lobko I, Lee BR. Successful conservative management of colorenal fistula after percutaneous cryoablation of renal-cell carcinoma. J Endourol. 2007;21:726-729PubMedCrossRefGoogle Scholar
  95. 95.
    Culkin DJ, Wheeler JS, Nemchausky BA, Fruin RC, Canning JR. Percutaneous nephrolithotomy: spinal cord injury vs. ambulatory patients. J Am Paraplegia Soc. 1990;13:4-6PubMedGoogle Scholar
  96. 96.
    McLaren RH, Barrett DM, Zincke H. Rectal injury occurring at radical retropubic prostatectomy for prostate cancer: etiology and treatment. Urology. 1993;42:401-405PubMedCrossRefGoogle Scholar
  97. 97.
    Long JP, Bahn D, Lee F, Shinohara K, Chinn DO, Macaluso JN Jr. Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cryosurgical ablation of the prostate. Urology. 2001;57:518-523PubMedCrossRefGoogle Scholar
  98. 98.
    Theodorescu D, Gillenwater JY, Koutrouvelis PG. Prostatourethral-rectal fistula after prostate brachytherapy. Cancer. 2000;89:2085-2091PubMedCrossRefGoogle Scholar
  99. 99.
    Chin JL, Pautler SE, Mouraviev V, Touma N, Moore K, Downey DB. Results of salvage cryoablation of the prostate after radiation: identifying predictors of treatment failure and complications. J Urol. 2001;165:1937-1941; discussion 1941-1942PubMedCrossRefGoogle Scholar
  100. 100.
    Menon M, Tewari A, Peabody JO, et al. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am. 2004;31:701-717PubMedCrossRefGoogle Scholar
  101. 101.
    Guillonneau B, Gupta R, El Fettouh H, Cathelineau X, Baumert H, Vallancien G. Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol. 2003;169:1694-1696PubMedCrossRefGoogle Scholar
  102. 102.
    Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol. 2003;169:1689-1693PubMedCrossRefGoogle Scholar
  103. 103.
    Bukowski TP, Chakrabarty A, Powell IJ, Frontera R, Perlmutter AD, Montie JE. Acquired rectourethral fistula: methods of repair. J Urol. 1995;153:730-733PubMedCrossRefGoogle Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  • Brett D. Lebed
    • 1
  • Eric S. Rovner
    • 1
  1. 1.Department of UrologyMedical University of South CarolinaCharlestonUSA

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