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.
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.
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.
This technique can sometimes better demonstrate the fistula and can differentiate ureterovaginal fistula from vesicovaginal fistula.
Larger tracts may be directly visualised with delayed phase contrast-enhanced CT 2.
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.
Treatment and prognosis
Surgical repair is often successful in the majority of cases. Prompt nephrostomy and ureteral stent placement should suffice in most cases 3.
- 1. Yu NC, Raman SS, Patel M et-al. Fistulas of the genitourinary tract: a radiologic review. Radiographics. 2004;24 (5): 1331-52. Radiographics (full text) - doi:10.1148/rg.245035219 - Pubmed citation
- 2. Botsikas D, Caviezel A, Becker CD et-al. A new MDCT technique for the detection and anatomical exploration of urogenital fistulas. AJR Am J Roentgenol. 2012;198 (2): W160-2. doi:10.2214/AJR.11.7092 - Pubmed citation
- 3. Dowling RA, Corriere JN, Sandler CM. Iatrogenic ureteral injury. J. Urol. 1986;135 (5): 912-5. - Pubmed citation