Urinary fistulas after prostate or pelvic surgery

A urinary fistula is an abnormal opening between the urinary tract organ that processes urine and carries it out of the body. A fistula can also form an abnormal connection between a urinary tract organ and another nearby organ such as the vagina or colon.

Various types of fistulas are mainly caused by injury to the organs, either during surgery or trauma.

Fistulas are more common in women. Men experience other types of fistulas as a complication of hypospadias or chordee repair.

• Vesicovaginal fistula- between the urinary tract and vagina
• Vesicouterine fistula- occurs between the bladder and the uterus
• Urethrovaginal fistula- between the urethra and the vagina
• Ureterovaginal fistula- fistula occurs between the ureter and the vagina
• Colovesical fistula- between the colon and the bladder
• Rectovaginal fistula- fistula between rectum and the vagina
• Urethrocutaneous fistulas - between the urethra and the perineum (in men)

Fistulas are painless, and the symptoms vary depending upon where the abnormal connection occurs.

• Irritation in the area of the vulva (external female genital organs)
• Frequent urinary tract infections
• Foul-smelling gas from the vagina
• Feces leaking into the vagina
• Fluid drainage from the vagina
• Abdominal pain
• Leaving gas from the urethra while urinating.

The most common type of urinary fistula occurs from injury to the bladder during

• abdominal or pelvic surgery such as hysterectomy or cesarean,
• pelvic malignancy such as cervical or colon cancer,
• radiation therapy for pelvic cancer, and
• any inflammatory bowel diseases like Crohn's disease.

The doctor will perform a thorough physical examination of the pelvic area. If the fistula is between the urinary tract and the vagina, then the doctor will be able to know during the examination.

The doctor would like to test to find the type, location, and severity of the fistula to recommend treatment options.

• MRI,
• Radionuclide cystogram,
• Retrograde cystogram,
• Computed tomography (CT or CAT) scan,
• Intravenous urography,
• Cystoscopy,
• Retrograde pyelography,
• Ultrasound.

Depending on the type of fistula, the doctor may help the patient's urinary tract function correctly without urine passing through the fistula.

Small fistulas that are detected early in the stage can be treated by a urinary catheter to drain the bladder.

Some patients who have a ureterovaginal fistula may have a small stent placed in the ureter. The stent makes the urine flow correctly from the kidneys to the bladder while the fistula heals.

Surgery:

Since a fistula is an unwanted connection between two organs, the treatment for most fistulas is surgical repair.

Some surgeries are done through the vagina and some through the abdomen. For some laparoscopic is done which uses only small incisions or with robotic surgery that involves very precise movements.

The surgery is done to repair the fistula so that, healthy tissue can grow and close the fistula opening, and restoring the normal function of the organs that are affected. The surgeon will remove the damaged tissue or the tumor that could be affecting the fistula.

If the fistula is large and is related to the bowel or colon then colostomy is recommended before the surgery. The procedure will keep the fistula clear for the surgery. After the area of the fistula heals, the doctor will be able to remove the colostomy.

After the surgery:

Most patients will have a catheter in the bladder for 12-14 days and it is removed once the fistula area is healed.