Genitourinary fistula, or vesicovaginal fistula, is defined as an abnormal passage between the vagina and bladder.
Most commonly, there is passage of urine from either the ureters, bladder, or urethra into the uterus, cervix, or vagina. Causes can include trauma (e.g., auto accident), pelvic or colorectal cancer, hysterectomy, radiation treatment, or infection.
In developing countries, genitourinary fistulas are often the result of prolonged labor and delivery, resulting in perforations in the vaginal wall and urinary tract. A small number of genitourinary fistulas are congenital.
The most common symptom of genitourinary fistula is the passage of urine through the vagina. Secondary symptoms may include urinary tract infection, odor, stained clothing, and genital tissue irritation. An abscess, which is an inflamed mass of cells and pus, may eventually form around the area of irritation.
Because the passage of urine is involuntary, patients are frequently embarrassed by their condition and do not discuss it with their physician. This is unfortunate because, over time, genitourinary fistula can lead to medical complications, social isolation, and a loss of quality of life. However, by disclosing the condition, and providing pertinent details such as frequency of urinary leakage, more effective treatment is likely.
A pelvic examination will help verify the existence of the fistula (or fistulas), its general location, and severity. Cystoscopy, which involves inserting a small camera into the bladder, is then performed to assess the extent and severity of the condition. In many cases, a voiding cystourethrogram, which is an X-ray that is taken while the patient is urinating, is performed. It is followed by a CAT scan (with contrasting dye) to better visualize the organs and ensure that neighboring ureters have not been affected.
There are several different treatment methods for this condition that an experienced urologist can recommend and perform.
If the fistula is small enough, it can heal on its own. To aid in this process, prolonged Foley catheter drainage with bladder rest may be attempted. Another option is to use a special adhesive compound or natural protein to aid in the natural healing of the injured site.
In most cases, laparoscopic reconstruction surgery is needed for patients who suffer from genitourinary fistula. During this procedure, small incisions are made to gain access to the urological and genital tissues. Tissues may be excised from one portion of the patient's body, and then grafted into affected areas to repair their damage. Adjacent injured muscles may also undergo surgical repair during this time.
Traditional, scalpel-based surgery may also be required to fully repair damaged tissues and ensure that they have sufficient tissue overlap or graft.
Following surgery, patients will undergo antibiotic treatment to eliminate any possible infection resulting from the fistula or its repair.