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.
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.
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.
This technique can sometimes demonstrate the fistula better and can differentiate ureterovaginal fistula from vesicovaginal fistula.
Larger tracts may be directly visualised with delayed contrast-enhanced CT 2.
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.
Treatment and prognosis
Surgical repair is often successful in the majority of cases. Prompt nephrostomy and ureteral stent placement could 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