Abnormal epithelialized tract communicating between urinary & genital tracts.
( according to anatomical situation)
1. Uretro-uterine fistula.
2. Uretro-cervical fistula.
3. Uretro-vaginal fistula.
1. Vesico-uterine fistula.
2. Vesico-cervical fistula.
3. Vesicovaginal fistula.
C. Urethral: urethro-vaginal fistula.
D. Combined: e.g. cervico-vesico-vaginal fistula.
Genitourinary fistula (Ureteric injuries & uretro-vaginal fistula)
Uretro-vaginal fistula definition:
1) Congenital: very rare.
2) Traumatic: * surgical trauma: common.
* Obstetric trauma: rare.
Types of ureteric injuries:
1) Transection complete or partial.
2) Inclusion of a ligature.
3) Crushing during clamping of a structure.
4) Resection of a segment.
5) Excessive dissection of ureter causing
♦ During operation (suspected by a senior surgeon)
1) Urine appears in the field with the urinefrous odour.
2) Ureter distends in the field after a tying suture.
3) If indigocarmine injected, appearance of violet dye in the field.
♦ After operation
1) History: of operation or a trauma.
2) Symptoms: *usually: partial incontinence.
*Rarely: complete incontinence.
General: as vesico-vaginal fistula.
Abdominal: as vesico-vaginal fistula.
Local: *fistula is felt or seen at the anterior vaginal wall.
*Usually small and situated near the lateral vaginal fornix.
♦ Urinoma: may collect i.e. pelvic abscess or escape i.e. fistula formation.
♦ Stormy picture: peritonism manifestations appear.
1) Methylene blue test: upper gauze is soaked with urine.
2) Cystoscopy: *intact bladder.
*Absent ureteric reflux on the affected side.
*Ureteric catheter stops on the affected site.
3) IVP: to detect site & side of fistula.
♦Preoperative IVP to visualize the course of ureter.
♦Preoperative ureteric catheterization via cystoscopy.
♦ Ureteric identification during operation & any clamping is done under vision.
♦ Proper surgical technique & applying the artery forceps to bleeding point exactly.
B. Active treatment:
Treatment of fistula:
1. Segmental resection and end to end anastomosis.
2. Pulling the ureter into urinary bladder (reimplantation).
3. Boari’s flap operation.
– Indication: high ureteric injury.
– Method: a tube-like connection between the lower end of the ureter &UB is created by bladder flap excised and remodeled.
Treatment of complication:
1. Immediate evacuation of urinoma.
2. Nephrostomy for stormy picture.
Urethro- vaginal fistulaaetiology:
Trauma is usually the incriminated cause.
Urethro- vaginal fistulaC/P:
1. The patient is continent (As fistula level below the sphincter).
2. Double stream of urine on micturition or vaginal drippling from vagina.
Urethro- vaginal fistulatreatment:
vaginal repair resolve the condition.
Vesico-uterine fistulaaetiology: Surgical e.g. abdominal operations as CS ….. (rare)
If lies above the isthmus leads to menouria.
(Cyclic hematuria occurs due to escape of blood from uterus to urinary bladder
1. Preventive: Proper separation of bladder during operations e.g. CS.
2. Active: abdominal repair is sufficient.