An abnormal opening of, or connection to, a urinary tract organ is called a fistula. There are many types of fistulas, but all types can lead to increased morbidity and diminished physical activity.
- The vesicouterine fistula occurs between the uterus and the bladder and is between the vagina and the urinary tract.
- The urethrovaginal fistula is between the ureter and the vagina
- The rectovaginal fistula occurs between the rectum and vagina.
Fistulas are almost always caused by injury, such as a car accident, or during surgery such as a cesarean section. In developed countries, urinary fistulas may occur after hysterectomies, but in underdeveloped countries, obstetric trauma is usually responsible for the problem. Fistulas are very rare and occur in less than 1% of patients who undergo a hysterectomy. They usually only develop in more complex hysterectomies or in instances of severe blood loss during the surgery.
Symptoms from fistulas vary dramatically. Some fistulas cause constant urine leakage from the vagina, frequent urinary tract infections, diarrhea, fever, vomiting, or nausea. A doctor will want to examine a patient believed to have a fistula and may find the fistula during a physical exam. In order to visualize the fistula after the initial doctor’s visit, the physician will likely order an MRI or a retrograde cystogram, both of which visualize the internal organs. Patients with a fistula will often complain of side and abdominal pain and occasionally of unusual discharge or liquid from the vagina. Examinations may be painful and patients may have to be placed under general anesthesia to be evaluated for further treatment.
While some small, early fistulas can be treated with a catheter, most fistulas will require surgery. Surgical repair can fix the undesired opening or connection between two organs. Trans-abdominal surgery is the most common surgery. While it is safer for the patient if the surgeon were to gain access to the fistula through the vagina, it can be very difficult to do so. The main goal of vesicovaginal fistula surgery is to separate the two organs and create a watertight closure to keep the vagina and bladder separate.