Genitourinary Fistula

What Is Genitourinary Fistula?

A fistula is an abnormal opening or connection between two different organs inside the body, such as between the bowel and the vagina; or two blood vessels, such as between an artery and a vein. With a genitourinary fistula the abnormal passage may occur between the vagina and the bladder, urethra or ureter. It may between the bladder and the bowel, urethra and the perineum, skin, bowel or rectum. Fistulas can cause urine to leak or drain from inappropriate pathways separate from its natural course between the kidneys and the urethra. Genitourinary fistula types include ureterovaginal, ureterouterine, urethrovaginal, vesicouterine, vesicovaginal, colovesical, rectourethral, and urethrocutaneous fistulas.

What Causes Urinary Fistula?

Many genitourinary fistulas can be caused by trauma, surgery, radiation, infections or during delivery.

Further causes in detail:

• Pelvic surgery: colorectal, gynecological and urologic surgeries (e.g. colectomies, hysterectomies, urethroplasties)
• Prior radiation: prior radiation for pelvic cancers can lead to later development of genitourinary fistulas (e.g. Radiation for colon cancer, prostate cancer, cervical cancer)
• Infections like diverticulitis can lead to fistulas
• Prolonged or obstructed labor may be a less likely cause in the United States
• Other conditions: untreated pelvic or genitourinary malignancies, untreated urethral strictures, or retained foreign bodies (e.g. pessaries), or prior radiation exposure to the pelvis

How Do You Know If You Have a Urinary Fistula?

Genitourinary fistula symptoms include:

• Continuous urinary leakage from the vagina. Leakage may be continuous or intermittent and can be confused with stress incontinence
• Voiding small amounts of urine, as the bladder never gets full
• Urinary tract infections; flank pain, or fevers may be a sign of a kidney infection or an ascending urinary tract infection
• Urinating out small amounts of fecal material or urinating out air, discolored urine
• Urine or fluid draining from perineum, penis or scrotum
• Liquid bowel movements, concerning for urine

Treatment

Genitourinary fistulas can be debilitating. Not all fistulas require surgical intervention. Some fistulas can be treated with conservative or non-surgical treatments when detected and diagnosed early.

Sometimes early surgical intervention helps enable better results when genitourinary fistula repair is the treatment. However, surgery may be delayed to allow the fistula tract to mature and inflammation to decrease. There are various surgical approaches to genitourinary fistulas, which will be discussed in detail and tailored on a per patient basis. If you have a genitourinary fistula, your urologist can work with you to map out a treatment plan that works best for your situation.