Ureterovaginal fistula

Dr Ian Bickle et al.

Ureterovaginal fistulas refer to abnormal fistulous communications between the ureter 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 after pelvic surgery or trauma.

Ureterovaginal fistulas commonly result as a complication of hysterectomy. Other less common causes include pelvic trauma and irradiation of pelvic neoplasms.

Associations

Many times, they are co-existent with vesicovaginal fistulas, which will have a similar presentation. It is important to recognise these fistulas in such settings, as their management differ considerably.

The diagnosis may be made by direct visualisation with vaginoscopy and cystourethroscopy.

Excretory urography

Usually, a vaginal swab is kept during the procedure, which gets soaked with contrast. Although differentiation with vesicovaginal fistula is still difficult using this technique, good and well-timed oblique images may demonstrate the ureterovaginal fistula.

Retrograde pyelography

This technique can sometimes demonstrate the fistula better and can differentiate ureterovaginal fistula from vesicovaginal fistula.

CT 

Larger tracts may be directly visualised with delayed contrast-enhanced CT 2.

MRI

May also allow 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 could suffice in most cases 3.

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Article Information

rID: 26012
System: Urogenital
Section: Pathology
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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