Ureterovaginal fistula: a case series.

Journal Article (Journal Article)

INTRODUCTION AND HYPOTHESIS: We describe the presentation, diagnosis, and management of ureterovaginal fistula over a 7-year period at a tertiary care center. METHODS: A retrospective review of ureterovaginal fistula cases between 2003 and 2011 was performed. Demographic information, antecedent event, symptoms, diagnostic modalities, and management strategies were reviewed. RESULTS: Nineteen ureterovaginal fistulas were identified during the 7-year study period. One fistula followed a repeat cesarean section and 18 fistulas followed a hysterectomy (9 total abdominal, 6 total laparoscopic, 3 vaginal hysterectomies). Ureteral injuries were not recognized in any of the patients at the time of index surgery. Computed tomography (CT) urography was the most commonly utilized diagnostic modality (58%). Primary non-surgical management with ureteral stents was attempted and successful in 5 out of 7 cases (71%). There were 14 total surgical repairs, including 2 cases in which stents were successfully placed, but the fistula persisted, and 6 additional cases where attempted stent placement failed. Surgical repair consisted of 10 ureteroneocystostomies performed via laparotomy and 4 performed laparoscopically, 3 of which were robotically assisted. CONCLUSIONS: Despite being uncommon, ureterovaginal fistula should remain in the differential diagnosis of new post-operative urinary incontinence after gynecological surgery. Conservative management with ureteral stent appears to be the best initial approach in selected patients, with a success rate of 71%. Minimally invasive approaches to performing ureteroneocystostomy have high success rates, comparable to those of open surgical repair.

Full Text

Duke Authors

Cited Authors

  • Shaw, J; Tunitsky-Bitton, E; Barber, MD; Jelovsek, JE

Published Date

  • May 2014

Published In

Volume / Issue

  • 25 / 5

Start / End Page

  • 615 - 621

PubMed ID

  • 24346812

Electronic International Standard Serial Number (EISSN)

  • 1433-3023

Digital Object Identifier (DOI)

  • 10.1007/s00192-013-2272-y

Language

  • eng

Conference Location

  • England