An introduction to urogenital fistulae: incidence, etiology, classification, symptomatology and how we diagnose them

Česká verzia

Authors: Antonín Prouza ¹; Lyudmila Vyacheslavovna Tikhonova ²
Authors place of work: Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom ¹; Urology Clinic, JSC European Medical Center, Moscow, Russia ²
Published in the journal: Ces Urol 2020; 24(4): 261-276
Category: Review article

Summary

Prouza A, Tikhonova VL. An introduction to urogenital fistulae: incidence, etiology, classification, symptomatology and how we diagnose them.

The aim of this text is to introduce the topic of urogenital fistulae to the reader. Whereas obstructed labour is the most common cause of fistula formation in the developing countries, it is a quite rare complication in the developed world, where it usually occurs as a result of an unrecognized intraoperative injury of the urinary tract, mainly so during hysterectomy. Pelvic radiotherapy and inflammatory disease are some of the less frequent causes of fistula formation in the developed countries. The presence of involuntary urine loss througout the day and especially at night during sleep is a typical sign of a fistula. A high level of suspicion for possible urogenital fistula formation must be addressed if these symptoms are associated with some of the risk factors included in the patient’s history. Detailed history and physical examination with dye tests may be sufficient in order to reach the correct diagnosis, however retrograde urethrogram and voiding cystourethrogram are routinely used in the diagnostic work‑up. CT urogram is a mandatory investigation used to exclude possible upper urinary tract involvement. We also use urethrocystoscopy with biopsy of the fistula tract if suspicion of malignancy arises in the preoperative assessment of the fistula. The conservative and surgical management of urogenital fistualae is beyond the scope of this text and will be discussed in great detail in our future review article.

Keywords:

urogenital – fistula – vesicovaginal – obstetric – iatrogenic

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