Genitourinary Fistula

A fistula is essentially a hole that exists where there shouldn't be one.

Sometimes referred to as a urinary fistula, a genitourinary fistula is an abnormal connection or passageway between the urinary and genital structures. Often associated with urinary incontinence, genitourinary fistulas are usually treated with surgery. They typically develop around:

• The bladder
• The tubes that connect to the kidneys (ureters)
• The tube that carries urine out of the body (urethra)
• Reproductive organs like the uterus, vagina, and cervix

What Causes Genitourinary Fistulas?

While men sometimes experience genitourinary fistulas, it's an abnormality more common in women. The cause is usually damage related to surgery or structural trauma experienced from a difficult childbirth. It's also possible to develop a fistula as a result of an accident or injury affecting the pelvic area. Some women develop fistulas following a hysterectomy. Less common causes and contributing factors include:

• Issues related to radiation treatment
• Severe urinary or pelvic infections
• Certain forms of cancer affecting the pelvic area
• Inflammatory bowel disease

Possible Symptoms

It's possible to have genitourinary fistulas with little or no symptoms. However, it's usually when there's some type of persistent abdominal discomfort or issues such as recurrent urinary tract infection (UTIs) that patients become aware of a potential problem. Some patients may also experience gas passing through the urethra during urination. Women with a genitourinary fistula might notice vaginal odor, urine leakage from the vagina, or feces leaking into the vagina.

How Are Genitourinary Fistulas Diagnosed?

A urologist often uses medical history, a review of symptoms, and a series of tests to positively diagnose a genitourinary fistula. In addition to a complete blood count and a urine test, patients may also have dye tests done to trace the source of urine leaks. Locating a fistula in the pelvic area sometimes requires a flexible sigmoidoscopy, a visual examination of the anus and rectum with a lighted scope with a camera attached to it. If a suspected fistula in this area is difficult to find, a computerized tomography (CT) urogram or MRI may be performed.

Treatment Options

If a genitourinary fistula is small and the tissues around it are healthy, non-surgical treatments may be recommended before surgery is considered. In some cases, this involves the use of a urinary catheter or a small stent to improve urine flow to allow the fistula to heal. Most of the time, surgery is a more effective treatment. Depending on the specific location of the fistula, surgery may be done through the vagina or lower abdomen.

Most procedures involve closing the fistula and removing damaged tissues to restore normal urinary and reproductive system functioning. A large fistula may require the creation of an opening in the stomach (colostomy). If this is done, the opening is usually closed once the fistula heals. Most procedures include the temporary use of a catheter post-surgery to ensure sufficient bladder emptying as the surgical area heals.

The most common reason for genitourinary fistulas is abdominal or pelvic surgeries or issues related to childbirth, including cesarean sections. Yet this doesn't make the condition entirely preventable. What you can do, however, is report any unusual vaginal discharge or changes in urination habits after surgery or trauma in the pelvic area to your doctor.