Clinical Conditions

The most common type of fistula involving these systems is a vesicovaginal fistula, in which the woman's vagina is connected to the urinary bladder. This causes leakage of urine from the vagina and results in frequent vaginal and bladder infections. Fistulas may also develop between the vagina and the large intestine (a enterovaginal fistula)or rectum (rectovaginal fistula) so that feces leaks from the vagina. Fortunately both these types of fistulas are uncommon in the developed world, however, they are all too common in poor developing countries and result from long, difficult labor and childbirth, especially in very young girls. As a result, they are sometimes referred to as obstetric fistulas.

In some parts of Africa, it estimated that as many as 3-4 per 1000 vaginal deliveries women develop these fistulas. Others estimate that as many as 2 million women worldwide are living with unrepaired obstetric fistulas. If left unrepaired, these urogenital fistulas result in constant vaginal leakage urine and feces. Young women with these conditions can become social outcasts, causing them extreme hardship and psychological trauma.Vaginal fistulas are classified into four types; treatment varies for each:

  • Vesicovaginal fistulas, occur between the vagina and urinary bladder. This is the most common type of vaginal fistula.
  • Uterovaginal fistulas occur between the vagina and distal ureter (ureters are ducts that carry urine from the kidney to the bladder)
  • Urethrovaginal fistulas, also called urethral fistulas, occur between the vagina and urethra
  • Rectovaginal fistulas, occur between the vagina and the rectum

Causes and Symptoms

The causes and symptoms of fistulas vary depending on their location. Anal and rectal fistulas are usually caused by an abscess. Symptoms include constant throbbing pain and swelling in the rectal area. Pus is sometimes visible draining from the fistula opening on the skin. Many individuals have a fever resulting from the infection causing the abscess.

Vaginal fistulas are caused by infection and trauma to the tissue during childbirth. They are easily detected, because the woman smells unpleasant and leaks urine or feces through her vagina. In the United States, urogenital fistulas are less commonly resultant from obstetric trauma and more likely result from surgical complications (following hysterectomy), from pelvic abscess or from other pelvic inflammatory conditions.

Diagnosis

A thorough history usually identifies risk factors that may lead to a vaginal fistula, such as recent pelvic surgery, infection or prior pelvic radiation. An initial exam usually includes a visual exam with a speculum. Additional diagnostic testing may include dye tests, cystoscopy, retrograde pyelograms, fistulagrams and other imaging studies as needed.

Treatment Options

Conservative (nonsurgical) therapy is rarely effective; most vaginal fistulas require surgery to close the opening. Vaginal fistulas are usually treated with surgery through the abdomen or vagina. In certain cases it can be treated with laparoscopic or robotic surgery.