URINARY FISTULAE

Urinary Fistulae

Definition

• Urinary fistula: Abnormal communication between urinary tract and skin or another organ.

Types

• Vesicovaginal fistula (VVF): Abnormal connection between bladder and vagina.
  • Congenital: Present at birth, often due to developmental abnormalities.
  • Acquired: Develops after injury, surgery, or disease.
• Urethrovaginal fistula: Abnormal connection between urethra and vagina.
• Ureterovaginal fistula: Abnormal connection between ureter and vagina.
• Colovesical fistula: Abnormal connection between colon and bladder.
• Retroperitoneal fistula: Abnormal connection between urinary tract and skin or other organs in the retroperitoneal space.

Pathology

• VVF often caused by:
  • Prolonged obstructed labor
  • Pelvic surgery
  • Pelvic radiation
  • Infection
• Urethrovaginal fistula often caused by:
  • Urethral injuries
  • Pelvic surgery
  • Pelvic radiation
• Ureterovaginal fistula often caused by:
  • Ureteral injuries
  • Pelvic surgery
  • Pelvic radiation
• Colovesical fistula often caused by:
  • Diverticulitis
  • Inflammatory bowel disease
  • Cancer
• Retroperitoneal fistula often caused by:
  • Trauma
  • Cancer
  • Infection

Clinical Features

• Symptoms:
  • Continuous urinary leakage
  • Painful urination
  • Frequent urinary tract infections
  • Recurrent urinary incontinence
• Physical examination:
  • Urine leakage may be seen during urination or incontinence episodes
  • Abdominal examination may reveal a mass or tenderness

Investigations

• Imaging:
  • Urinary tract imaging (e.g., ultrasound, CT urogram)
  • Fistulogram (contrast study)
  • Invasive imaging (e.g., cystoscopy, sigmoidoscopy)
• Urine analysis:
  • Urine culture to rule out infections
  • Urine dipstick test for blood or protein
• Clinical history and examination

Complications

• Recurrent urinary tract infections
• Chronic kidney damage
• Electrolyte imbalances
• Malnutrition

Management

• Conservative management: Addressing underlying causes (e.g., pelvic floor physical therapy)
• Surgical management: Repair of the fistula
  • Step 1 → Step 2 → Step 3
    • Step 1: Ureteral catheterization to prevent urine flow through fistula
    • Step 2: Closure of the fistula with sutures or grafts
    • Step 3: Closure of the incision site

Treatment

• Step 1 → Step 2
  • Step 1: Repair of underlying cause (e.g., urethral injury)
  • Step 2: Closure of the fistula with sutures or grafts
• Step 1 → Step 2 → Step 3
  • Step 1: Ureteral catheterization to prevent urine flow through fistula
  • Step 2: Closure of the fistula with sutures or grafts
  • Step 3: Closure of the incision site

Homoeopathic Therapeutic Medicines:

• Calcarea carbonica: Urinary fistula due to chronic infection
• Lycopodium clavatum: Urinary fistula due to pelvic surgery or radiation
• Arsenicum album: Urinary fistula due to pelvic infection or chronic disease
• Graphites: Urinary fistula due to chronic constipation or bowel disease
• Nux vomica: Urinary fistula due to pelvic surgery or anesthesia complications