Urol. praxi. 2022;23(3):151-152 | DOI: 10.36290/uro.2022.041

Spontaneous healing of ureterovaginal fistula

MUDr. Jan Schraml, Ph.D.¹, MUDr. Marek Broul, Ph.D., MBA, FECSM^{1, 2}, MUDr. Filip Cihlář, Ph.D.³

¹ Klinika urologie a robotické chirurgie Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské zdravotní, a. s. - Masarykovy nemocnice v Ústí nad Labem, o. z.

² Sexuologické oddělení Masarykovy nemocnice v Ústí nad Labem, o. z., Krajská zdravotní, a. s.

³ Radiologická klinika Fakulty zdravotnických studií Univerzity J. E. Purkyně v Ústí nad Labem a Krajské zdravotní, a. s. - Masarykovy nemocnice v Ústí nad Labem, o. z.

While in developing countries obstetric trauma due to prolonged labour is the most common cause of genitourinary fistulas, these complications are fortunately relatively rare in developed countries. Here, a genitourinary fistula usually occurs as a result of an unrecognized iatrogenic injury to the urinary tract during surgery; typically hysterectomy. Radiotherapy to the pelvic area or pelvic inflammatory disease are some of the less common causes of fistulas. Continuous diurnal and nocturnal uncontrolled urine leakage is a very characteristic feature which, in the presence of risk factors associated with possible fistula formation, prompts the doctor to consider this relatively rare diagnosis. A thorough medical history, a comprehensive urogynaecological physical examination, and a dye test are the initial diagnostic steps which are often capable of reliably diagnosing a fistula. In terms of imaging studies, retrograde and voiding cystourethrography and a contrast-enhanced CT scan of the urinary tract to rule out concurrent ureteral injury are used routinely. Cystography requires both anteroposterior and lateral projection in order to determine the exact location of the fistula. When indicated, urethrocystoscopy complemented with biopsy of suspicious lesions is an integral part of preoperative diagnostic tests (1). Open surgical repair has so far been the classic management of this condition. Recently, however, the use of laparoscopic and robotic surgery has expanded the management options for ureteral injury. Other treatment options are ureteral stent placement and percutaneous nephrostomy alone or in combination with ureteral stent placement (2). We report a case of a female patient in whom spontaneous healing of a ureterovaginal fistula occurred.

Keywords: urogenital fistula, spontaneous healing, iatrogenic urinary tract injury, retrograde and voiding cystourethrography and a contrast-enhanced CT scan.

Accepted: October 10, 2022; Published: October 12, 2022  Show citation