Several types of pelvic fistulas secondary to pelvic diseases or surgeries have already been described: vesicovaginal, vesicouterine, ureterovaginal, ureteroenteric, enterovaginal and rectovaginal fistulas. The close proximity of pelvic organs makes the genitourinary system susceptible to injury, so the majority of fistulas occur in the pelvic cavity,
Ureterovaginal fistulas occur most frequently after gynecologic or obstetric surgeries, usually as a sequela of an iatrogenic lesion of the ureter, but also may appear after a pelvic radiotherapy.
Coexistent vesicovaginal fistula is common. Patients present with urinary incontinence per the vagina sometimes accompanied by fever and chills usually within 2–4 weeks following surgery, as urine has collected in the pelvis and dissected into the vaginal suture line. The diagnosis may be established radiographically with , excretory urography, and retrograde pyelography, as well as with CT and MR imaging . Excretory urography is sensitive and may reveal extravasation of contrast material in a collection outside the ureter, eventually draining into the vaginal cavity . The presence of an obstructed ureter in patients with vaginal drainage may also suggest the diagnosis .
IMAGING STUDY
(a)Fistulography is the most direct means of visualizing a fistula and should be considered when feasible (eg, cutaneous types).
(b) Intravenous urography (IVU) and pyelography or ureterography are mainstays of upper tract investigation.
(c) Likewise, voiding cystourethrography (VCUG) and urethrography are central to the study of the lower tract.
(d) Cross-sectional techniques, in particular CT, are providing increasingly more diagnostic power and are considered the primary test in some cases.
Other types of fistulas
1.Ureteroileal fistula
Fistulas between the ureter and the alimentary tract may involve the duodenum, jejunum, ileum, and colon. Ureterocolic fistulas are most common and can be caused by urinary calculi, iatrogenic trauma, diverticulitis, radiation therapy, transitional cell carcinoma, and tuberculosis . Ureteroileal fistulas may complicate Crohn disease but may also be caused by iatrogenic or accidental trauma.
Other types of fistulas
1.Ureteroileal fistula
Fistulas between the ureter and the alimentary tract may involve the duodenum, jejunum, ileum, and colon. Ureterocolic fistulas are most common and can be caused by urinary calculi, iatrogenic trauma, diverticulitis, radiation therapy, transitional cell carcinoma, and tuberculosis . Ureteroileal fistulas may complicate Crohn disease but may also be caused by iatrogenic or accidental trauma.
2)Ureterocutaneous fistula
Ureterocutaneous fistulas may occur as a consequence of iatrogenic trauma , xanthogranulomatous pyelonephritis and urinary calculous disease
3)Vesicouterine Fistula
Vesicouterine fistulas are rarely encountered. The condition is almost exclusively secondary to cesarean section, in which the bladder may sustain trauma owing to its proximity to the lower uterine segment. Women primarily present with intermittent urine leakage or incontinence, cyclical hematuria (menouria), and apparent amenorrhea. These symptoms in the presence of a patent cervix have been designated Youssef syndrome.
Ureterocutaneous fistulas may occur as a consequence of iatrogenic trauma , xanthogranulomatous pyelonephritis and urinary calculous disease
3)Vesicouterine Fistula
Vesicouterine fistulas are rarely encountered. The condition is almost exclusively secondary to cesarean section, in which the bladder may sustain trauma owing to its proximity to the lower uterine segment. Women primarily present with intermittent urine leakage or incontinence, cyclical hematuria (menouria), and apparent amenorrhea. These symptoms in the presence of a patent cervix have been designated Youssef syndrome.
4. Sigmoidovesical fistulas
5. Ileovesical fistulas