A urinary fistula can be an abnormal opening between urinary tract organs that process urine and carry it out of the body (kidneys, ureter tubes, bladder, urethra). Urinary fistulas can also form an abnormal connection between a urinary tract organ and another nearby organ such as the vagina or colon. Vagina/urinary organ connections are often called vaginal fistulas.
Essentially, a fistula is a hole in the bladder, vagina or other organ that allows urine, stool or other matter to pass where it should not. The result can be feces and urine leaking from the vagina due to that abnormal connection.
Numerous types of fistula are possible:
Fistulas are most common in females. Males sometimes experience other types of urinary fistulas as a complication of hypospadias or chordee repair.
Vaginal fistulas are much more common in developing regions without adequate healthcare. In these areas, very difficult childbirth can create tissue damage that sometimes causes fistulas to open.
Fistulas are not very common in developed countries such as the U.S. But they still can occur from one of the causes below.
Damage to the tissues of the urinary tract, pelvic region or vagina can create the conditions for a fistula. Urinary fistulas can develop from an injury or accident, a surgery, radiation treatment or (less often) by an infection. The fistula may open after tissue breaks down over time, from days to years.
Fistulas usually are painless. Most people become aware that they have a fistula because of their symptoms. These symptoms might include:
To understand an individual’s fistula, the physician first will conduct an examination. He or she will discuss the patient’s medical history to determine the possible cause of the fistula or other risk factors. The doctor probably will perform a pelvic examination.
The physician may recommend additional tests to determine the precise location of the fistula and the best way to treat it. These tests might include:
The physician will use these tests to determine the type, location and severity of the fistula. Then he or she can recommend treatment options.
Some fistulas may only require conservative therapy. However, most fistulas need surgery to repair them.
Some simple fistulas may be able to heal on their own. This might be possible when the fistula is small and the tissue around the fistula is healthy. For instance, where tissue has not been damaged by radiation therapy or cancer.
To allow a fistula to heal, a doctor may try to help a person’s urinary tract function correctly without urine passing through the fistula. Some patients might need to use a urinary catheter to drain the bladder. People with an ureterovaginal fistula might have a small stent (a tube that holds the ureter open) placed in the ureter. This stent can help urine flow correctly from the kidneys to the bladder while the fistula heals.
Most fistulas require surgical repair. The type and location of the fistula will determine the type of surgery. Some surgeries are done through the vagina and some are done through the abdomen. Some cases can be corrected with laparoscopic surgery, which uses only small incisions, or with robotic surgery involving very precise movements.
The goal of surgery is to repair the fistula so that healthy tissue can grow and close the fistula opening, restoring normal function of the organs that are affected. The surgeon will work to remove damaged tissue and any other material (such as a tumor) that could be affecting the fistula.
Before surgery, the physician will work to make the tissue in the area of the fistula as healthy as possible. This may include medications or wound care to help the tissue heal.
If the fistula is large and involves the bowel or colon, the doctor may recommend a colostomy before the surgery. This procedure will keep the fistula clear for the surgery. Once the area of the fistula heals, the doctor usually is able to remove the colostomy.
After the fistula repair surgery, most patients will have a catheter in the bladder for a few weeks. The catheter can be removed once the fistula area has healed.