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.
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 can include urinary leakage, recurrent genital or urinary tract infections, irritated skin around your genitals, and even abscesses, which are pus-filled lumps under the skin that indicate infection.
To diagnose a genitourinary fistula, your doctor will likely start with a physical exam and a review of your health history for risk factors, such as pelvic radiation treatments or recent pelvic surgery. Other tests may also be used in diagnosis, including tests with dye to determine whether there is leakage between your urinary system and your genitals. X-rays may also be used to aid in diagnosis, either alone or in conjunction with dye.
Some minor fistulas may heal on their own. In the case of a bladder fistula, your doctor may insert a urinary catheter to drain the urine from your bladder and allow the tissue to heal. Sometimes a ureteral stent, or a device that holds the ureter open, may be placed to help urine flow away from a ureteral fistula. In some cases, it is possible to seal the fistula with a medical-grade glue or a plug made of proteins.
Unfortunately, most fistulas require surgery to close the abnormal opening. In some cases, minimally invasive surgery, such as laparoscopic surgery, is appropriate. In laparoscopic surgery, doctors only need to make small incisions and can use tiny cameras and instruments to complete the surgery. The smaller incisions needed for laparoscopic surgery can reduce healing time. Robotic surgery is another form of minimally invasive surgery which permits a three-dimensional view of the surgery site. However, some fistulas require traditional abdominal surgery because of their placement.
Some different surgical solutions include sewing a patch of special medical-grade material over the abnormal opening, taking tissue from another part of your body to patch the opening, and folding nearby healthy tissue over the opening.