★ ★ ★ ★ ★★ ★ ★ ★ ★ Verified rating
We left very happy with the doctor-patient relationship
It occurs due to an abnormal connection between the urinary tract and other organs or tissues. Although it is a rare condition, it can appear after certain surgeries, treatments, or injuries and cause persistent symptoms that require specialist evaluation.
A urinary fistula is an abnormal connection between the bladder or urethra and the exterior (the skin) or another cavity (usually the vagina or rectum). This abnormal connection of the urinary tract with other structures can be of different types: urethrovaginal, vesicovaginal, ureterovaginal, and vesicouterine.
It is a rare condition, and its most common symptoms are involuntary urine leakage, recurrent urinary tract infections, and the passage of urine through the rectum or, alternatively, stool (fecaluria) or gas (pneumaturia) through the urethra. Treatment for a urinary fistula involves correcting this abnormal connection to restore the integrity of the affected organs and improve quality of life.
The main cause of rectal fistulas in men is prostate or rectal surgery, often as a complication of prostate or rectal cancer treatment. However, other procedures involving the prostate or digestive tract can also cause them, though less frequently.
In women, it can occur after childbirth or due to gynecological tumors of the uterus, ovaries, or vagina, urinary incontinence surgery, mesh placement for prolapse, or removal of urethral diverticula. In both sexes, it can also occur as a result of digestive tumors (rectum, sigmoid colon) or radiation therapy.
Its treatment through surgery should be addressed by a multidisciplinary team, made up of urologists, colorectal surgery specialists and experts in urological reconstructive surgery.
Depending on the organs involved, the location, the patient's medical history, and the size of the fistula, it can be operated on using different approaches. The most common are through the vagina in women and the perineum (the area between the testicles and the anus) in men, although in the case of large fistulas, reoperations, a history of radiotherapy, or other circumstances, a laparoscopic or open abdominal approach may be required.
In very specific cases, injecting certain compounds into the fistula tract can improve symptoms. However, it is usually a partial or temporary solution.
In most patients, provided there is no history of radiotherapy, a cure can be achieved in a single procedure. However, many other factors can influence these treatment outcomes, such as the duration of the fistula, its cause, and the type of surgery required.
After the operation, a urethral catheter will be needed, and sometimes another catheter called a suprapubic catheter (inserted through the skin, in the area between the navel and the pubic bone) will also be required. These are usually left in place while the tissues heal, generally between 2 and 4 weeks. Before removing the catheters, a contrast test (urethrocystography) is performed to confirm that the fistula has closed.
Urinary fistulas have a significant impact on the quality of life of those who suffer from them. The main symptoms they produce include:
Normally, the urinary system is completely separate from the alimentary canal. When urinary fistulas occur, they can be the result of:
Based on the symptoms shown by the patient and their medical history, the necessary diagnostic tests will be carried out.
This is an imaging diagnostic method that uses X-rays to create cross-sectional images of the body. It allows visualization of the presence of gas within the bladder, or the fistula tract itself, when the examination is performed with contrast.
It is another diagnostic imaging technique that uses X-rays to obtain real-time images of the patient's internal structures. It allows for the diagnosis of primary diseases such as diverticulitis or Crohn's disease.
They can help in the evaluation of tests for colon disease.
This test can diagnose most cases. It involves examining the lining of the bladder and urethra (the tube that carries urine out of the body) using a cystoscope, which is a hollow tube with a lens that is inserted through the urethra.
Sometimes a biopsy is also done to see if there is any disease in the intestine, when cancer is suspected.
For this test, patients must consume poppy seeds and then have a urine test. If particles of the seeds are found in the urine, the test is positive and a fistula is diagnosed, although it does not specify the location of the fistula nor does it assess the intestinal wall.
While studying the poppy seed test, doctors discovered that the test provides 100% accuracy in diagnosis, making it the most accurate test available.
If a fistula is present, this substance will appear in the urine as black particles. This test does not indicate the fistula's location, but it is useful for confirming the diagnosis in suspected cases.
Rectal administration of vital dyes: This test has been recommended for the diagnosis of occult colovesical fistula. However, the dye can be absorbed and excreted in the urine even in the absence of a fistula.
Some fistulas may require only conservative therapy. However, most fistulas require surgical intervention for repair.
Some simple fistulas can heal on their own. This may be possible when the fistula is small and the surrounding tissue is healthy. For example, when the tissue has not been damaged by radiation therapy or cancer.
To treat a fistula, the doctor may try to help the person's urinary tract function properly without urine passing through the fistula. Some patients may need to use a urinary catheter to drain the bladder. People with a ureterovaginal fistula may have a small catheter (a tube that keeps the ureter open) placed in the ureter. This catheter can help urine flow properly from the kidneys to the bladder while the fistula heals.
Most fistulas require surgical repair. The type and location of the fistula will determine the type of surgery. Some surgeries are performed through the vagina, and others through the abdomen. Some cases can be corrected with laparoscopic surgery, which uses small incisions, or with robotic surgery , which allows for very precise movements.
The goal of surgery is to repair the fistula so that healthy tissue can grow and close the fistula opening, restoring normal function to the affected organs. The surgeon will work to remove damaged tissue and any other material, such as a tumor, that may be affecting the fistula.
Before surgery, the doctor will work to ensure the tissue in the fistula area is as healthy as possible. This may include medication or wound care to help the tissue heal.
If the fistula is large and affects the intestine or colon, the doctor may recommend a colostomy before surgery. This procedure will keep the fistula clear for the surgery. Once the fistula area has healed, the doctor can usually remove the colostomy.
After surgery, most patients will have a catheter in their bladder for a few weeks. The catheter can be removed once the fistula area has healed.
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
We treat our patients at the ROC Chamberí clinic and in the HM Hospitals network of centers in Madrid: Sanchinarro, Montepríncipe, Madrid Río, Rivas, Puerta del Sur, Nuevo Belén, Policlínico HM Moraleja and Nuevo Norte.
Coming soon
We left very happy with the doctor-patient relationship
Our patients' trust reflects our commitment to providing excellent, personalized, and attentive urological care. Every experience motivates us to continue improving and offering the care and support each patient needs.
Excellent urological clinic due to the professionals who work there.
A highly professional clinic, with a very high scientific level and advanced technology. They helped me solve my urological problem.
I can only say one thing, the urology girls are the best you can find in this...
I want to express my gratitude to the Roc team, especially Dr. David Carracedo, for their professionalism, the...
Excellent care, both from Dr. Rojo and Dr. Espinales on a medical level and from the staff of...
Top 100 deal
I've been coming to the Urology department at HM Monteprincipe for a long time and I'm very happy with the care I receive from...
