Urinary Fistula

What is a urinary fistula?

A urinary fistula is an abnormal communication between the bladder or urethra with the exterior (skin) or another cavity (usually vagina or rectum). This abnormal communication of the urinary tract with other structures can be of different types: urethrovaginal, vesicovaginal, ureterovaginal and vesicouterine.

It is a rare pathology and its most common symptoms are involuntary urine leaks, repeated urine infections together with the emission of urine through the rectum or, alternatively, of feces (fecaluria) or gas (pneumaturia) through the urethra. The treatment of urinary fistula consists of correcting this abnormal communication to restore the integrity of the organs involved and improve the quality of life.

The main cause of rectal fistula in men is prostate surgery or rectal surgery, as a complication of prostate or rectal cancer treatment. Although other procedures on the prostate or digestive system can also produce it to a lesser extent.

In women, it can appear after childbirth or gynecological tumors of the uterus, ovaries or vagina, urinary incontinence interventions, placement of mesh for prolapse or removal of urethral diverticula. In both sexes, it can also occur as a consequence of digestive tumors (rectum, sigma) or radiotherapy.

Its treatment by surgery must be approached by a multidisciplinary team, made up of urologists, colorectal surgery specialists and experts in urological reconstructive surgery. The Ministry of Health itself recommends that patients be treated in referral centers.

Depending on the organs involved, the location, the patient's history and the size of the fistula, it can be operated by different routes. The most common are through the vagina in women and the perineum in men (space between the testicles and the anus), although in the case of large fistulas, re-interventions, a history of radiotherapy or other circumstances, a laparoscopic or open abdominal approach may be required.

In very specific cases, injection of certain compounds into the fistula tract may improve symptoms. However, this is usually a partial or temporary solution.

In most patients, provided there is no history of radiotherapy, cure can be achieved in a single operation. However, there are many other factors that can influence these treatment results, such as the duration of the fistula, the cause or the type of surgery required.

After the operation, a urethral catheter will be needed and, sometimes, the placement of another catheter called suprapubic (through the skin, in the area between the navel and the pubis). They are usually maintained while the tissues heal, generally between 2 and 4 weeks. Before the catheters are removed, a contrast test (urethrocystography) is performed to confirm that the fistula is closed.

Complications

The most common possible complications are recurrence of the fistula or injury to neighboring organs. There is the possibility of bleeding that very occasionally requires transfusion or urgent surgical reintervention.

The alternative of not operating is valid, but it forces the patient to use absorbents (diapers, compresses...) or to wear a catheter permanently with its possible associated complications (bleeding, infection, poor tolerance).