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Fistula

A fistula is an abnormal passageway or opening between two organs or between an organ and skin, resulting from tissue damage usually caused by injury or infection.

A vaginal fistula begins with some kind of tissue damage. After days or even years of tissue breakdown, a fistula opens up. Vaginal fistulae in women are very common in developing countries as the result of prolonged labor (obstetric fistulae). In the United States, obstetric fistulae are far less common due to advanced ob/gyn services and the higher rate of cesarean-section deliveries. However, a gynecologic fistula may result from an injury during pelvic surgery, a difficult abdominal hysterectomy or previous pelvic radiation treatment. Damage to the bladder during a cystocele (prolapse) repair may result in vesicovaginal fistulae (connecting the urinary bladder and vagina) or ureterovaginal fistulae (connecting the ureters and vagina).

A rectovaginal fistula (connecting the rectum and vagina) or enterovaginal fistula connecting small intestine and vagina) may result as a complication of delivery, surgery and in people suffering such inflammatory bowel diseases as Crohn's disease, ulcerated colitis and diverticulitis.

The most common type of fistula occurs between the bladder and the colon (enterovesical fistula). This type of fistula, often the result of diverticular disease, affects men more often than women because the uterus insulates these organs in women. It can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.

A rectourinary fistula can also develop in a man treated with radiation for such pelvic malignancies as prostate or rectal cancer. These fistulae are often challenging to treat and require a physician trained in multidisciplinary specialties.

Symptoms of a Fistula

  • Sore or infected genital area
  • Abdominal pain
  • Malodorous urine
  • Incontinence
  • Urinary tract infection
  • Continuous leakage from vagina
  • Urinary leakage from rectum

Testing for a Fistula

  • Physical exam
  • Pelvic exam
  • Double dye (tampon) test (vesicovaginal or ureterovaginal fistulae)
  • Enema test (rectovaginal fistulae)
  • Lateral cystograms or CT cystograms
  • Cystoscopy
  • Vaginoscopy
  • Proctoscopy
  • Radiological imaging

Treatment for a Fistula

Treatments for urinary fistula repair usually involve surgery combined with antibiotic therapy. Vesicovaginal fistulae can be treated using an abdominal or a vaginal approach, depending on the location of the fistula or the surgeon's preference. A vaginal approach, when possible, is the least invasive and allows for the fastest recovery period.

Robotically assisted laparoscopic surgery has also been proven effective to repair most types of fistulae. A rectovaginal fistula may require a colostomy before surgery to divert the waste from the involved area.



Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.

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