Table 2 Categorisation, causes and mechanisms of urinary vaginal fistulas
Type | Cause | Notes |
|---|---|---|
Ureterovaginal | Surgical injury | Intraoperative injury to the distal ureter Risk further increased by parametrial and nodal dissection Often via formation of urinoma that drains into the vaginal vault |
- Most frequent (75% of cases): total abdominal or radical hysterectomy | ||
- Less common procedures: laparoscopic treatment of endometriosis, surgery for ovarian cancer, complex urological or lower gastrointestinal pelvic surgeries | ||
Vesicovaginal + urethrovaginal | Surgical injury | Intraoperative injury to urinary bladder Often with formation of urinoma that drains into the vaginal vault Sometimes via necrosis of vaginal vault from incorrectly placed sutures between the vaginal cuff and posterior aspect of bladder |
- Same interventions as above plus | ||
- Emergency caesarean section | ||
- Anti-incontinence procedures, cystocele repair, resection of urethral diverticulum | ||
Locally advanced malignancies | Rare, e.g. uterine cervix carcinomas, urethral/bladder transitional carcinomas | |
Past irradiation such as for uterine cervix carcinoma | Delayed onset (years after treatment) Increasingly uncommon | |
Perineal laceration | From direct trauma (most usually sexual violence) | |
Obstetric complication (spontaneous or instrumental delivery) | Historical, still today in developing countries lacking obstetric practices Via pressure necrosis of the anterior vaginal wall and bladder neck, compressed between the foetal head and the symphysis pubis |