In third world countries (parts of Africa, the Middle East and India), the most common cause of all fistula (urinary and fecal) is prolonged vaginal birth and associated birth injuries. In the United States, where access to Cesarean delivery is readily available, the most common cause of urinary fistula shifts to surgical complications. In the U.S., vesicovaginal fistula are most commonly associated with hysterectomies.
What are the symptoms of a Urinary Fistula?
The most common symptom of a urinary tract fistula is constant urine leakage from the vagina. Other common symptoms include urinary tract infections, chronic skin irritation and unpleasant odor.
How are Urinary Fistula diagnosed?
The diagnosis of a urinary fistula begins with a careful medical and surgical history, followed by a detailed physical exam. While expensive tests are available to diagnose fistula, the majority can be located on physical exam by a trained surgeon. If the initial physical exam does not reveal the fistula tract, your doctor may choose to perform a “dye test,” in which sterile water is stained blue and placed inside the bladder via a catheter. A vaginal exam is then performed looking for the area of blue fluid leakage. If the test is still unclear, your doctor may place clean, white gauze pads inside the vaginal vault and have you walk around for 5 minutes; if a fistula is present, the blue dye will leak out onto the white gauze pads, revealing a fistula. If the diagnosis is still uncertain, other tests such as cystourethrograms can demonstrate the location of the fistula.
How are Urinary Fistula treated?
The answer to this question depends on the size, location and age of the fistula. Small fistula that have developed recently may spontaneously close with continuous bladder drainage. In other words, some of these connections can heal and close by themselves if a foley catheter is kept in place for several weeks. While this is uncommon, it does happen more than one might think, a great alternative to surgery.
While some of these fistula can be treated through continuous foley drainage, the majority will require surgical repair. Most vesicovaginal fistula can be closed through the vagina by a trained vaginal surgeon. Other fistula are not good “candidates” for a transvaginal approach and must be closed through an abdominal procedure.
Following surgery for the urinary fistula, a patient will wear a foley catheter for 14 days and will be given an anticholinergic medication to prevent bladder spasms. At their 2-week follow-up appointment, the foley catheter will be removed and the patient will be encouraged to avoid heavy lifting for 5-6 more weeks.