Ureterovaginal fistulae refer to abnormal communications between the lumina of the ureter(s) and the vagina.
On this page:
Clinical presentation
Patients usually present with urinary incontinence through the vagina which may be accompanied by fever and chills 1. Symptoms usually begin within 2-4 weeks following pelvic surgery or trauma.
Pathology
Ureterovaginal fistulae are commonly a complication of hysterectomy. Other less common causes include pelvic trauma and radiation therapy of pelvic neoplasms.
Associations
They are often coexistent with vesicovaginal fistulas, which have a similar presentation. It is important to recognize and distinguish between these fistulae in such settings, as their management differs considerably.
Radiographic features
The diagnosis may be made by direct visualization with vaginoscopy and cystourethroscopy.
Excretory urography
Usually, a vaginal swab is applied during the procedure, which becomes soaked with contrast. Although differentiation from vesicovaginal fistula is still difficult using this technique, good quality, well-timed oblique images may demonstrate the ureterovaginal fistula.
Retrograde pyelography
This technique can sometimes better demonstrate the fistula and can differentiate ureterovaginal fistula from vesicovaginal fistula.
CT
Larger tracts may be directly visualized with delayed phase contrast-enhanced CT 2.
MRI
MRI may also afford direct visualization of larger tracts. T2-weighted MR imaging with single-shot fast spin-echo sequences, half-Fourier rapid acquisition with relaxation enhancement (RARE) technique, or delayed contrast-enhanced T1-weighted gradient-recalled-echo (GRE) sequences with fat saturation may be useful for diagnosis.
Treatment and prognosis
Surgical repair such as ureteral reimplantation is often successful in the majority of cases. Prompt nephrostomy and ureteral stent placement should suffice in most cases 3,4.