Uretero-vaginal fistula refers to a fistulous contact between ureter and vagina, which were most commonly related with hysterectomy. Many times they were co-existent along with vesico-vaginal fistula, which are having same presentation. It was important to identify this fistula in such settings, as their management will differs significantly.
Some common symptoms linked along with uretero-vaginal fistula were, urinary incontinence by vagina, Fever and chills can be associated with the incontinence. Symptoms generally begins within 2-4 weeks after the surgery was done. Clear drainage per vagina, nausea unilateral hydroureteronephrosis & flank pain secondary to partial ureteral obstruction, flank pain, fever and clear vaginal drainage subsequent by pelvic surgery was very suggestive of ureteral injury.
Most of the causes are secondary to unrecognized distal ureteral injuries sustained during gynecologic methods like anti-incontinence surgery, vaginal or abdominal hysterectomy, cesarean section. Other causes like: Pelvic malignancy, Endoscopic instrumentation, penetrating pelvic trauma, radiation therapy, , other pelvic surgery (vascular, enteric, etc.).
Tests that are involved to diagnose uretero-vaginal fistula are:
Intravenous urography – Urogram can be demonstrated by partial obstruction, drainage into the vagina and hydroureteronephrosis.
Cystoscopy and retrograde pyelography – These will be done to estimate the bladder injury and to observe the distal ureteral segment if it was not well seen on the urogram. An attempt at retrograde stenting was reasonable if the pyeloureterogram demonstrate ureteral continuity. Extended internal diversion along with ureteral stenting can result in resolution of the fistula.
CT/MRI – Cross-sectional imaging may be helpful to evaluate the pelvic malignancy when evaluate or indicated for an urinoma in the patients suffering with persistent fevers.
Cystogram or cystometrogram – In some cases where the long segment of distal ureter was involved and Boari flap was being consider for the reconstruction may also be helpful to evaluate the vesicoureteral reflux and bladder capacity.
A surgical repair was usually successful in majority of cases. A ureteral stent placement and prompt nephrostomy should suffice in most of the cases.