Ureterovaginal fistula

Mr Andrew Murphy and Dr Ian Bickle et al.

Ureterovaginal fistulae refer to abnormal communications between the lumina of the ureter(s) and the vagina

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.

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 recognise and distinguish between these fistulae in such settings, as their management differs considerably.

The diagnosis may be made by direct visualisation 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 visualised with delayed phase contrast-enhanced CT 2.

MRI

MRI may also afford direct visualisation 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.

Surgical repair is often successful in the majority of cases. Prompt nephrostomy and ureteral stent placement should suffice in most cases 3.

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Article information

rID: 26012
System: Urogenital
Synonyms or Alternate Spellings:
  • Uretero-vaginal fistula
  • Vagino-ureteric fistula
  • Vagino-ureteric fistulation
  • Vaginoureteric fistulae
  • Vaginoureteric fistulas
  • Ureterovaginal fistulae
  • Ureterovaginal fistulation
  • Uretero-vaginal fistula
  • Vaginoureteric fistula

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Cases and figures

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    Case 1: post hystrectomy
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    MIP
    Case 2: post hystrectomy
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    Case 3: congenital
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    Case 4: post hysterectomy
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    Case 5: post hystrectomy
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