Types of urinary fistulas
- Vesicovaginal - the most common in women; urine constantly leaks through the vagina
- Ureterovaginal - usually a consequence of damage to the ureter during gynecological surgery
- Urethro-vaginal
- Vesicointestinal - communication with the intestine, more often with diverticulitis, Crohn's disease, tumors
- Vesicouterine - after cesarean section
- Urinary fistula on the skin - after operations, injuries, with long-standing drainages
- Urethral fistula - after operations on the urethra, with complications of circumcision and urethroplasty
- Pyelocutaneous and ureterocutaneous fistulas - after nephrostomies and interventions on the upper urinary tract
Reasons
- Gynecological surgeries, primarily hysterectomy, are the leading cause of vesicovaginal fistulas.
- Prolonged labor with prolonged standing of the fetal head and tissue ischemia
- Caesarean section
- Surgeries on the rectum and pelvic organs
- Radiation therapy - fistulas can take years to appear and heal worse than others
- Tumors of the pelvic organs with invasion
- Inflammatory bowel disease, diverticulitis
- Pelvic injuries and fractures
- Prolonged standing of the catheter, bedsore of the wall
- Endoscopic operations and complications after them
Отдельно о лучевых свищах: ткани после облучения плохо кровоснабжаются и хуже заживают, поэтому такие свищи требуют особой хирургической тактики — обычно с использованием хорошо кровоснабжаемых лоскутов и после более длительной подготовки.
Symptoms
- Constant leakage of urine from the vagina - day and night, regardless of the urge
- For small fistulas, leakage occurs only in a certain position of the body
- Preservation of normal urination with simultaneous leakage is a characteristic sign of a ureteric fistula
- Irritation, redness and maceration of the skin of the perineum and thighs
- Persistent odor of urine
- Recurrent urinary tract infections
- Pneumaturia - release of air in the urine - and fecaluria with vesico-intestinal fistula
- Urine leakage through a surgical scar
- Psychological consequences: anxiety, avoidance of communication, decreased quality of life
Diagnostics
- Speculum examination by a gynecologist with assessment of the location of the leak
- Dye test: a colored solution is injected into the bladder and where it comes out is assessed - a simple and informative test
- Three-tampon test to clarify the level of the fistula
- Cystoscopy - visualization of the opening of the fistula from the side of the bladder, assessment of the condition of the mucosa and location relative to the orifices of the ureters
- Cystography and vaginography
- CT urography with delayed phase - determination of the course of the fistula and the condition of the ureters
- MRI of the pelvis for complex and radial fistulas
- Excretory urography for suspected ureteral fistula
- Colonoscopy and CT for vesicointestinal fistula
- Biopsy of the edges of the fistula with a history of cancer - it is necessary to exclude tumor recurrence
Treatment
- Conservative management with long-term drainage of the bladder with a catheter - sometimes allows very small fistulas identified immediately after surgery to close
- Ureteral stenting for ureterovaginal fistula - in some cases the fistula closes on its own
- Surgical closure of the fistula is the main method; access can be vaginal, abdominal or laparoscopic
- The use of well-supplied tissue flaps for radiation and recurrent fistulas
- Ureterocystoneostomy for ureteral injury
- Resection of the affected area of the intestine with vesico-intestinal fistula
- Urethrovesicoanastomosis and reconstructive surgery for complex defects
- Urinary diversion (cystostomy, urethrostomy) as a temporary or final option in severe cases
- Treatment of infection and skin care during the preparation phase
Время операции имеет значение. Раннее вмешательство возможно при свежих свищах, выявленных сразу. В остальных случаях выжидают, пока стихнет воспаление и сформируются края свища, — это существенно повышает шансы на успешное закрытие с первой попытки. А первая попытка всегда самая результативная.
After surgery
- Long-term bladder drainage with a catheter is key to healing; the catheter cannot be removed prematurely
- Sexual rest for a period determined by the surgeon
- Limiting physical activity and heavy lifting
- Prevent constipation and cough - increased pressure in the abdomen interferes with healing
- Antibacterial therapy for infection
- Control cystography before catheter removal
- Observation by a urologist and gynecologist
- Discussion of the method of delivery in subsequent pregnancies
Where are urinary fistulas treated in Tashkent
For diagnosis, cystoscopy, cystography and CT urography are needed, and for treatment, a surgeon skilled in reconstructive urology and various approaches is needed.
In Tashkent, examination and surgical treatment of urinary fistulas are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
The main thing to know is that you don’t have to put up with this condition and don’t have to endure it for years. Fistulas are successfully closed surgically, and the most effective is the first, well-planned operation. Clinic contacts are below.
