Genitourinary Fistula

A genitourinary fistula is an abnormal opening between the genitals and the urinary system which can allow urine to leak into other organs.

Fistulas are more common in women than in men. The most common type of genitourinary fistula is a bladder fistula, in which the opening occurs between the genitals and the urinary bladder. In the United States, bladder fistulas are most commonly caused by damage during pelvic surgery.

In women, bladder fistulas may be between the vagina and bladder (called a vesicovaginal fistula), and may occur because of a previous hysterectomy or a difficult labor.
Fistulas may also occur after pelvic radiation, or after a physical trauma such as a car accident or giving birth.

Types of Genitourinary Fistulas

Fistulas can develop in different parts of the urinary system

These abnormal connections allow urine to leak into nearby tissues

Location of the fistula determines symptoms and treatment

Urinary fistulas can occur between the genitals and ureters, the ducts that carry urine from the kidneys to the bladder. Fistulas can also occur between your genitals and the urethra, the passage that carries urine out of the body.

Symptoms of Genitourinary Fistulas

Symptoms of genitourinary fistulas can vary depending on the location of the abnormal opening and are often related to infection, irritation, and abnormal urine leakage.

Urinary leakage is one of the most common symptoms associated with fistulas.

Recurrent genital or urinary tract infections may occur.

Skin irritation around the genitals may develop due to constant moisture.

Some patients develop abscesses, which are pus-filled lumps under the skin that indicate infection.

How Genitourinary Fistulas Are Diagnosed

Dye tests may be used to determine whether urine is leaking between the urinary system and genitals

Imaging tests such as X-rays may be used to help identify the location of the fistula

Dye and imaging may sometimes be used together during diagnostic evaluation

To diagnose a genitourinary fistula, your doctor will likely begin with a physical exam and a review of your health history for risk factors such as pelvic radiation treatments or recent pelvic surgery.

Treatment Options

Treatment for genitourinary fistulas depends on the severity and location of the abnormal opening.

Some minor fistulas may heal on their own

A urinary catheter may be inserted to drain the bladder and allow tissue to heal

A ureteral stent may help urine flow away from a ureteral fistula

Medical-grade glue or protein plugs may sometimes seal the fistula

Surgical Repair

Surgical Closure

Unfortunately, most fistulas require surgery to close the abnormal opening.

Minimally Invasive Options

In some cases, laparoscopic surgery may be used. This technique requires only small incisions and uses tiny cameras and surgical instruments to repair the fistula. Robotic surgery may also be used and allows surgeons to view the surgical site in three dimensions.

Traditional Surgical Repair

Some fistulas require traditional abdominal surgery because of their placement. Surgical solutions may include sewing a patch of medical-grade material over the opening, using tissue from another part of the body to patch the area, or folding nearby healthy tissue over the opening.