Abstract
Bladder fistulas involve an abnormal connection between bladder and either vagina or intestine. In this review chapter, we cover the etiology, clinical presentation, and various surgical approaches to repairing vesicovaginal and enterovesical fistulas. The long-term sequela after surgical repair includes recurrent incontinence, lower urinary tract symptoms, infection, and vaginal stenosis. Strategies to approach fistula repair to minimize these complications are emphasized.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Browning A. Obstetric fistula: current practicalities and future concerns. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):333–4.
Sellers W, Fiorelli R. Enterovesical fistula secondary to squamous cell carcinoma of the bladder. Urol Case Rep. 2015;3(6):201–3.
Hillary CJ, Osman NI, Hilton P, Chapple CR. The aetiology, treatment, and outcome of urogenital fistulae managed in well-and low-resourced countries: a systematic review. Eur Urol. 2016. Recent and comprehensive review article
Gutman RE, Dodson JL, Mostwin JL. Complications of treatment of obstetric fistula in the developing world: gynatresia, urinary incontinence, and urinary diversion. Int J Gynaecol Obstet. 2007;99 Suppl 1:S57–64.
Creanga AA, Genadry RR. Obstetric fistulas: a clinical review. Int J Gynaecol Obstet. 2007;99 Suppl 1:S40–6.
Genadry RR, Creanga AA, Roenneburg ML, Wheeless CR. Complex obstetric fistulas. Int J Gynaecol Obstet. 2007;99 Suppl 1:S51–6.
Thomas K, Williams G. Medicolegal aspects of vesicovaginal fistulae. BJU Int. 2000;86(3):354–9.
Morrison PD, Addison NV. A study of colovesical fistulae in a district hospital. Ann R Coll Surg Engl. 1983;65(4):221–3.
Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 2004;188(5):617–21.
Daniels IR, Bekdash B, Scott HJ, Marks CG, Donaldson DR. Diagnostic lessons learnt from a series of enterovesical fistulae. Colorectal Dis. 2002;4(6):459–62.
Pushkar DY, Dyakov VV, Kasyan GR. Management of radiation-induced vesicovaginal fistula. Eur Urol. 2009;55(1):131–7. Addresses radiation induced fistulas specifically.
Ballek NK, Gonzalez CM. Reconstruction of radiation-induced injuries of the lower urinary tract. Urol Clin North Am. 2013;40(3):407–19.
Liberman D, Mehus B, Elliott SP. Urinary adverse effects of pelvic radiotherapy. Transl Androl Urol. 2014;3(2):186–95.
Turina M, Mulhall AM, Mahid SS, Yashar C, Galandiuk S. Frequency and surgical management of chronic complications related to pelvic radiation. Arch Surg. 2008;143(1):46–52. discussion.
Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract. 2013;2013:617967. Complete review article on enterovesical fistulas.
Kwon EO, Armenakas NA, Scharf SC, Panagopoulos G, Fracchia JA. The poppy seed test for colovesical fistula: big bang, little bucks! J Urol. 2008;179(4):1425–7.
Solkar MH, Forshaw MJ, Sankararajah D, Stewart M, Parker MC. Colovesical fistula—is a surgical approach always justified? Colorectal Dis. 2005;7(5):467–71.
Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thuroff J. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol. 2009;182(3):978–82.
Angioli R, Penalver M, Muzii L, Mendez L, Mirhashemi R, Bellati F, et al. Guidelines of how to manage vesicovaginal fistula. Crit Rev Oncol Hematol. 2003;48(3):295–304.
Narayanan P, Nobbenhuis M, Reynolds KM, Sahdev A, Reznek RH, Rockall AG. Fistulas in malignant gynecologic disease: etiology, imaging, and management. Radiographics. 2009;29(4):1073–83.
Waaldijk K. Surgical classification of obstetric fistulas. Int J Gynaecol Obstet. 1995;49(2):161–3.
Goh JT. A new classification for female genital tract fistula. Aust N Z J Obstet Gynaecol. 2004;44(6):502–4. Urodynamic data post-fistula repair.
Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol. 1995;153(4):1110–2. discussion 2-3.
Eilber KS, Kavaler E, Rodriguez LV, Rosenblum N, Raz S. Ten-year experience with transvaginal vesicovaginal fistula repair using tissue interposition. J Urol. 2003;169(3):1033–6.
Hilton P. Urogenital fistula in the UK: a personal case series managed over 25 years. BJU Int. 2012;110(1):102–10.
Waaldijk K. The immediate management of fresh obstetric fistulas. Am J Obstet Gynecol. 2004;191(3):795–9.
Frajzyngier V, Ruminjo J, Barone MA. Factors influencing urinary fistula repair outcomes in developing countries: a systematic review. Am J Obstet Gynecol. 2012;207(4):248–58.
Zambon JP, Batezini NS, Pinto ER, Skaff M, Girotti ME, Almeida FG. Do we need new surgical techniques to repair vesico-vaginal fistulas? Int Urogynecol J. 2010;21(3):337–42.
Gupta NP, Mishra S, Hemal AK, Mishra A, Seth A, Dogra PN. Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula. J Endourol. 2010;24(11):1779–82.
Hemal AK, Kolla SB, Wadhwa P. Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas. J Urol. 2008;180(3):981–5.
Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM. Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis. 2006;8(4):347–52.
Rangnekar NP, Imdad Ali N, Kaul SA, Pathak HR. Role of the Martius procedure in the management of urinary-vaginal fistulas. J Am Coll Surg. 2000;191(3):259–63.
Browning A. Lack of value of the Martius fibrofatty graft in obstetric fistula repair. Int J Gynaecol Obstet. 2006;93(1):33–7.
Petrou SP, Jones J, Parra RO. Martius flap harvest site: patient self-perception. J Urol. 2002;167(5):2098–9.
Ferguson GG, Lee EW, Hunt SR, Ridley CH, Brandes SB. Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg. 2008;207(4):569–72.
Ingber M, Rackley R. Vesicovaginal and Urethrovaginal Fistula Repair In: Goldman HB, editor. Complications of Female Incontinence and Pelvic Reconstructive Surgery Springer Science+Business Media 2013. p. 157-64
Arrowsmith SD. Urinary diversion in the vesico-vaginal fistula patient: general considerations regarding feasibility, safety, and follow-up. Int J Gynaecol Obstet. 2007;99 Suppl 1:S65–8.
Thaler K, Baig MK, Berho M, Weiss EG, Nogueras JJ, Arnaud JP, et al. Determinants of recurrence after sigmoid resection for uncomplicated diverticulitis. Dis Colon Rectum. 2003;46(3):385–8.
Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG. 2008;115(12):1564–9.
Carey MP, Goh JT, Fynes MM, Murray CJ. Stress urinary incontinence after delayed primary closure of genitourinary fistula: a technique for surgical management. Am J Obstet Gynecol. 2002;186(5):948–53.
Nardos R, Browning A, Member B. Duration of bladder catheterization after surgery for obstetric fistula. Int J Gynaecol Obstet. 2008;103(1):30–2.
Murray C, Goh JT, Fynes M, Carey MP. Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula. BJOG. 2002;109(7):828–32.
Browning A. Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular sling. BJOG. 2004;111(4):357–61.
Krause HG, Lussy JP, Goh JT. Use of periurethral injections of polyacrylamide hydrogel for treating post-vesicovaginal fistula closure urinary stress incontinence. J Obstet Gynaecol Res. 2014;40(2):521–5.
Hilton P, Ward A, Molloy M, Umana O. Periurethral injection of autologous fat for the treatment of post-fistula repair stress incontinence: a preliminary report. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(2):118–21.
Dolan LM, Dixon WE, Hilton P. Urinary symptoms and quality of life in women following urogenital fistula repair: a long-term follow-up study. BJOG. 2008;115(12):1570–4. Addresses long term quality of life parameters after vesicovaginal fistula repair.
Agarwal MM, Raamya SM, Mavuduru R, Mandal AK, Singh SK. Voiding dysfunction after repair of giant trigonal vesicovaginal or urethrovesicovaginal fistulae: a need for long-term follow-up. Indian J Urol. 2012;28(4):405–8.
Lee D, Dillon BE, Lemack GE, Zimmern PE. Long-term functional outcomes following nonradiated vesicovaginal repair. J Urol. 2014;191(1):120–4.
Muleta M, Rasmussen S, Kiserud T. Obstetric fistula in 14,928 Ethiopian women. Acta Obstet Gynecol Scand. 2010;89(7):945–51.
Elkins TE. Surgery for the obstetric vesicovaginal fistula: a review of 100 operations in 82 patients. Am J Obstet Gynecol. 1994;170(4):1108–18. discussion 18–20.
Occhino JA, Trabuco EC, Heisler CA, Klingele CJ, Gebhart JB. Changes in vaginal anatomy and sexual function after vaginal surgery. Int Urogynecol J. 2011;22(7):799–804.
Browning A, Fentahun W, Goh JT. The impact of surgical treatment on the mental health of women with obstetric fistula. BJOG. 2007;114(11):1439–41.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Drs. Yuh and Rothschild declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction
Rights and permissions
About this article
Cite this article
Yuh, L.M., Rothschild, J.G. Complications and Long-Term Sequelae of Bladder Fistula Repair. Curr Bladder Dysfunct Rep 11, 317–324 (2016). https://doi.org/10.1007/s11884-016-0398-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11884-016-0398-8