Urogenital fistula

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Urogenital fistula
Other namesUrogenital fistulas, urogenital fistulae

A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. [1] Urogenital fistulas vary in etiology (medical cause). Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. [1] Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. [2] Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas. [2] : 673 

Contents

Classification

Abnormal passageways or fistulas can exist between the vagina and bladder, ureters, uterus, and rectum with the resulting passage of urine from the vagina, or intestinal gas and feces into the vagina, in the case of a vaginal–rectal fistula. [1] These vaginal fistulas are named according to the origin of the defect:

The vagina is susceptible to fistula formation because the gastrointestinal tract and urinary system are relatively close to the vagina. [4] A small number of vaginal fistulas are congenital. [5] The presence of a vaginal fistula has a profound effect on the quality of life since there is little control over the passage of urine and feces through the vagina. [6] [7]

Urogenital fistulas are often classified according to their cause: obstetric fistula, congenital fistula and iatrogenic fistula. Urogenital fistulas can be classified by size and more specific anatomical location such as 'upper vagina' or 'posterior vaginal wall'.[ citation needed ]

Causes

In developed countries, the causes of fistulas are iatrogenic (caused by surgical accidents). Physician error and lack of training contribute to the unsuccessful treatment of obstetric fistulas in developing countries. [8] [6] Injuries to pelvic organs are a cause of fistulas. [8] [4] Most of those not caused by obstructed labor develop from injuries. An example of this would be the improper placement of an instrument during a hysterectomy. [9] Fistulas can form after long-term pessary use, [10] hysterectomies, malignant disease and pelvic irradiation, [4] [11] [1] pelvic surgery, cancer or a pelvic fracture. [4] [12] Fistulas are sometimes found after a cesarean section. [8] Providers can also inadvertently cause a fistula when performing obstetric or gynecological surgery. The more training the physician has had, the less likely a uro-vaginal fistula will occur. Some women develop more than one fistula. [8] [6]

Treatment

Surgery is often needed to correct a fistula leading to the vagina. Conservative treatment with an in-dwelling catheter can be effective for small and recently formed urinary fistulas. It has a success rate of 93%. [1] [4] Collagen plugs are used but have been found not to be successful. [6] The surgical treatment to correct can be approached in different ways. Surgery through the vagina is successful 90% of the time. Surgical correction can be accomplished by abdominal surgery, by laparoscopic and robot-assisted laparoscopic surgery. [13] The various treatments vary in frequency. The transvaginal approach is used 39% of the time, transabdominal/transvesical approach is used 36% of the time, the laparoscopic/robotic approach is used to treat 15% of urogenital fistulas and a combination of transabdominal-transvaginal approach is used 3% of the time. [1]

Epidemiology

Globally, 75 percent of urogenital fistulas are obstructive labor fistulas. The average age of a woman who develops a fistula due to prolonged labor is 28 years old. The average age of a woman who develops a fistula from other causes is 42 years old. [8] Women with a small pelvis are more likely to develop a fistula. Though rare, a fistula can form after the minimally invasive oocyte retrieval part of infertility treatment. [14] Urogenital fistulas (vesicovaginal) caused by surgical complications occur at a frequency of 0.8 per 1000. [1]

Rectovaginal fistulas

Abnormal passage of stool through the vagina is caused by a rectovaginal fistula. [15] Treatment is often surgical with the use of tissue grafts. [15] [16] The presence of bowel disease increases the risk of a rectovaginal fistula. [15] An entero-vaginal fistula can form between the bowel and the vagina. [17] Rectovaginal fistulae result from inflammatory bowel disease, Chrohn's disease trauma, or iatrogenic injury and diversions to other organs. [6] [18] Episiotomies can cause the formation of a rectovaginal fistula. [18]

See also

Related Research Articles

<span class="mw-page-title-main">Fistula</span> Abnormal connection between two epithelialized surfaces, often organs

A fistula in anatomy is an abnormal connection between two hollow spaces, such as blood vessels, intestines, or other hollow organs. Types of fistula can be described by their location. Anal fistulas connect the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula.

<span class="mw-page-title-main">Obstetric fistula</span> Hole that develops in the birth canal as a result of childbirth

Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may include depression, infertility, and social isolation.

In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the partial or total surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. Partial hysterectomies allow for hormone regulation while total hysterectomies do not.

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.

<span class="mw-page-title-main">Pelvic floor</span> Anatomical structure

The pelvic floor or pelvic diaphragm is a muscular partition separating the pelvic cavity (above), and perineal region (below). It is formed by the levator ani muscle and coccygeus muscle, and associated connective tissue.

<span class="mw-page-title-main">Vaginoplasty</span> Surgical procedure

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury. Labiaplasty, which alters the appearance of the vulva, can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.

<span class="mw-page-title-main">Rectovaginal fistula</span> Medical condition

A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.

<span class="mw-page-title-main">Cystocele</span> Medical condition

The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.

<span class="mw-page-title-main">Vesicovaginal fistula</span> Female urogenital fissure

Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF).

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

Hematocolpos is a medical condition in which the vagina is pooled with menstrual blood due to multiple factors leading to the blockage of menstrual blood flow. The medical definition of hematocolpos is 'an accumulation of blood within the vagina'. It is often caused by the combination of menstruation with an imperforate hymen. It is sometimes seen in Robinow syndrome, uterus didelphys, or other vaginal anomalies.

Vaginal hypoplasia is the underdevelopment or incomplete development of the vagina. It is a birth defect or congenital abnormality of the female genitourinary system.

Double dye test is useful for diagnosing vesicovaginal or ureterovaginal fistulae. For this test, the patient takes oral phenazopyridine (Pyridium) 200 mg three times a day, and indigo carmine or methylene blue is filled into the empty urinary bladder via a urethral catheter. Pyridium turns urine orange in the kidneys, and methylene blue turns urine blue in the bladder.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

<span class="mw-page-title-main">Ureterovaginal fistula</span> Medical condition

A ureterovaginal fistula is an abnormal passageway existing between the ureter and the vagina. It presents as urinary incontinence. Its impact on women is to reduce the "quality of life dramatically."

A urethrovaginal fistula is an abnormal passageway that may occur the urethra and the vagina. It is a sub-set of vaginal fistulas. It results in urinary incontinence as urine continually leaves the vagina. It can occur as an obstetrical complication, catheter insertion injury or a surgical injury.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

Transvaginal mesh, also known as vaginal mesh implant, is a net-like surgical tool that is used to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI) among female patients. The surgical mesh is placed transvaginally to reconstruct weakened pelvic muscle walls and to support the urethra or bladder.

<span class="mw-page-title-main">Vesicouterine fistula</span> Abnormal communication between the bladder and uterus

Vesicouterine fistula refers to an abnormal communication between the bladder and uterus. The first case of vesicouterine fistula was reported in 1908. It was however first described in 1957 by Abdel Fattah Youssef, an obstetrician and gynaecologist in Kasr el-Aini hospital, Cairo, Egypt. It is characterized by a vesicouterine fistula above the level of the internal os, absence of menstrual bleeding, cyclical presence of blood in urine and absence of urinary incontinence with a patent cervical canal following a lower segment caesarean section. Six of such cases had been reported by other clinicians before the term Menouria was coined by Youssef.

References

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  2. 1 2 3 4 Hoffman B, Schorge J, Schaffer J, Halvorson L, Bradshaw K, Cunningham F (2012). Williams Gynecology (2nd ed.). New York: McGraw-Hill Medical. pp. 677–683. ISBN   9780071716727. OCLC   779244257.
  3. ↑ Wong MJ, Wong K, Rezvan A, Tate A, Bhatia NN, Yazdany T (March 2012). "Urogenital fistula". Female Pelvic Medicine & Reconstructive Surgery. 18 (2): 71–8, quiz 78. doi:10.1097/spv.0b013e318249bd20. ISSN   2151-8378. PMID   22453314. S2CID   5759825.
  4. 1 2 3 4 5 Priyadarshi V, Singh JP, Bera MK, Kundu AK, Pal DK (June 2016). "Genitourinary Fistula: An Indian Perspective". Journal of Obstetrics and Gynaecology of India. 66 (3): 180–84. doi:10.1007/s13224-015-0672-2. PMC   4870662 . PMID   27298528.
  5. ↑ Fernández Fernández JÁ, Parodi Hueck L (September 2015). "[Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature]". Investigacion Clinica. 56 (3): 301–307. PMID   26710545.
  6. 1 2 3 4 5 Maslekar S, Sagar PM, Harji D, Bruce C, Griffiths B (December 2012). "The challenge of pouch-vaginal fistulas: a systematic review". Techniques in Coloproctology. 16 (6): 405–14. doi:10.1007/s10151-012-0885-7. PMID   22956207. S2CID   22813363.
  7. ↑ Cowgill KD, Bishop J, Norgaard AK, Rubens CE, Gravett MG (August 2015). "Obstetric fistula in low-resource countries: an under-valued and under-studied problem--systematic review of its incidence, prevalence, and association with stillbirth". BMC Pregnancy and Childbirth. 15: 193. doi: 10.1186/s12884-015-0592-2 . PMC   4550077 . PMID   26306705. Women with OF also suffer significant psychosocial repercussions, including isolation, divorce, loss of social roles—including the role of mother, for those whose infants are stillborn, loss of income, stigmatization, shame and diminished self-esteem.
  8. 1 2 3 4 5 Raassen TJ, Ngongo CJ, Mahendeka MM (December 2014). "Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries". International Urogynecology Journal. 25 (12): 1699–706. doi:10.1007/s00192-014-2445-3. PMC   4234894 . PMID   25062654.
  9. ↑ Cron J. "Lessons From the Developing World: Obstructed Labor and the Vesico-Vaginal Fistula". Medscape. Retrieved 2018-01-13.
  10. ↑ Abdulaziz M, Stothers L, Lazare D, Macnab A (May–June 2015). "An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse". Canadian Urological Association Journal. 9 (5–6): E400-6. doi:10.5489/cuaj.2783. PMC   4479661 . PMID   26225188.
  11. ↑ Mellano EM, Tarnay CM (October 2014). "Management of genitourinary fistula". Current Opinion in Obstetrics and Gynecology. 26 (5): 415–23. doi:10.1097/gco.0000000000000095. PMID   25105561. S2CID   428688.
  12. ↑ Patel DN, Fok CS, Webster GD, Anger JT (December 2017). "Female urethral injuries associated with pelvic fracture: a systematic review of the literature". BJU International. 120 (6): 766–773. doi: 10.1111/bju.13989 . PMID   28805298.
  13. ↑ Tenggardjaja CF, Goldman HB (June 2013). "Advances in minimally invasive repair of vesicovaginal fistulas". Current Urology Reports. 14 (3): 253–61. doi:10.1007/s11934-013-0316-y. PMID   23475747. S2CID   27012043.
  14. ↑ Spencer ES, Hoff HS, Steiner AZ, Coward RM (2017). "Immediate ureterovaginal fistula following oocyte retrieval: A case and systematic review of the literature". Urology Annals. 9 (2): 125–130. doi: 10.4103/UA.UA_122_16 . PMC   5405653 . PMID   28479761.
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  16. ↑ Taylor D (2017-04-24). "Rectovaginal Fistula Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy". Medscape.
  17. ↑ Kraemer M, Kara D (2016). "Laparoscopic surgery of benign entero-vesical or entero-vaginal fistulae". International Journal of Colorectal Disease. 31 (1): 19–22. doi:10.1007/s00384-015-2395-3. PMC   4701784 . PMID   26423060.
  18. 1 2 Das B, Snyder M (March 2016). "Rectovaginal Fistulae". Clinics in Colon and Rectal Surgery. 29 (1): 50–6. doi:10.1055/s-0035-1570393. PMC   4755772 . PMID   26929752.
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