Fistulas

A fistula is an abnormal pathway connection between a hollow body cavity, such as the bladder, and another hollow organ or the surface of the body. Women generally experience one of these types of fistulas:

• A vesicovaginal fistula is an abnormal passage between  the bladder and the vagina
• A urethro-vaginal fistula connects the urethra to the vagina.

Fistulas can cause severe urinary incontinence because the urine can bypass the urethra and the sphincter, which normally regulate the flow of urine. They can lead to constant, or almost constant, urine leakage.

These types of fistulas almost always result from complications from pelvic surgery (such as hysterectomy, prolapse repair and anti-incontinence surgery) or from childbirth injuries. Rarely, they may be caused by pelvic cancer.

Causes

In industrialized countries, like the United States, Canada, and Western Europe, fistulas usually result from surgical complications of relatively simple operations such as anti-incontinence procedures, hysterectomy, prolapse surgery, or urethral diverticulectomy. They can also be caused by catheters that remain inside the bladder, if not cared for properly. We see this situation most often in quadriplegic or paraplegic women and occasionally in otherwise normal women who have had a prolonged recovery after a devastating illness or injury.

Diagnosis

If you experience urinary incontinence shortly after childbirth, hysterectomy, or any type of vaginal surgery, your doctor will probably check to see if you have a fistula. We might also check if you have incontinence but there is no urine leaking from your urethra.

To diagnose a fistula, we start by examining the vagina to look for the source of the leakage. We may need to pass a catheter, fill the bladder, and look again, either with or without contrast dye for increased clarity. Occasionally, we may need to do an X-ray or computerized tomography (CAT) scan. We will also make sure that you have no other injuries to the bladder, urethra, or ureters.

Treatments

Repair of fistulas can be done through the vagina or from an open or laparoscopic abdominal approach. Typically, both sides of the fistula hole are closed with sutures and if possible we try to put healthy tissue over the site of closure to prevent the fistula from reforming.

At Mount Sinai, we generally repair the incontinence and the fistula at the same time. We have found that this cures both conditions in more than 90 percent of women.