Genitourinary Fistula: An Indian Perspective

  • Vinod PriyadarshiEmail author
  • Jitendra Pratap Singh
  • Malay Kumar Bera
  • Anup Kumar Kundu
  • Dilip Kumar Pal
Original Article



In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed.


The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature.

Materials and Method

During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database.


Mean age of the patient was 27 years (range 16–51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active.


Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.


Fistula Genitourinary Ureterovaginal Vesicocervical Vesicouterine 


Compliance with Ethical Requirements and Confilct of Interest

It is declared in the forwarding letter that according to our institutional protocol, ethical committee clearance is not required for the retrospective observational and analytic studies. As the present study is a retrospective analytical study, institutional ethical committee clearance is not obtained.


  1. 1.
    Wong MJ, Wong K, Rezvan A, et al. Urogenital fistula. Female Pelvic Med Reconstr Surg. 2012;18(2):71–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Hilton P, Ward A. Epidemiology and surgical aspectsof urogenital fistula: a review of 25 years experience in Southeast Nigeria. Int Urogynecol J Pelvic Floor. 1998;9:189–94.CrossRefGoogle Scholar
  3. 3.
    Ekanem EI, Ekanem AD, Ekabua JE et al. Review of obstetrics genito-urinary fistulae in the University of Calabar Teaching Hospital Calabar, Nigeria. Niger J Clin Pract. 2010;13(3):326–30.PubMedGoogle Scholar
  4. 4.
    De Ridder D. An update on surgery for vesicovaginal and urethrovaginal fistulae. Curr Opin Urol. 2011;21(4):297–300. doi: 10.1097/MOU.0b013e3283476ec8.CrossRefPubMedGoogle Scholar
  5. 5.
    Nawaz H, Khan M, Tareen FM, et al. Retrospective study of 213 cases of female urogenital fistulae at the department of urology & transplantation civil hospital Quetta, Pakistan. J Pak Med Assoc. 2010;60(1):28–32.PubMedGoogle Scholar
  6. 6.
    Dudderidge TJ, Haynes SV, Davies AJ, et al. Vesicocervical fistula: rare complication of caesarean section demonstrated by magnetic resonance imaging. Urology. 2005;65:174–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Ibeanu OA, Chesson RR, Echols KT et al. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol. 2009;113:6–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Karram MM. Lower urinary tract fistulas. In: Walters MD, Karram MM, editors. Urogynecology and reconstructive pelvic surgery. 3rd ed. Philadelphia: Mosby Inc; 2007. p. 450–9.Google Scholar
  9. 9.
    Starkman JS, Meints L, Scarpero HM, et al. Vesicovaginal fistula following a transobturator midurethral sling procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:113–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Goh JT, Browning A, Berhan B, et al. Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1659–62.CrossRefPubMedGoogle Scholar
  11. 11.
    Stovsky MD, Ignatoff JM, O’Conor VJ et al. Use of electrocoagulation in the treatment of vesicovaginal fistulas. J Urol. 1994;152:1443–4.PubMedGoogle Scholar
  12. 12.
    Welp T, Bauer O, Diedrich K. Use of fibrin glue in vesico-vaginal fistulas after gynaecologic treatment. (German). Zentralbl Gynakol. 1996;118:430–2.PubMedGoogle Scholar
  13. 13.
    Kumar S, Kekre NS, Gopalakrishnan G. Vesicovaginal fistula: an update. Indian J Urol. 2007;23:187–91.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kumar A, Goyal NK, Das SK, et al. Our experience with genitourinary fistulae. Urol Int. 2009;82:404–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Duong TH, Gellasch TL, Adam RA. Risk factors for the development of vesicovaginal fistula after the incidental cystotomy at the time of a benign hysterectomy. Am J Obstet Gynecol. 2009;201(5):512e1–4.CrossRefGoogle Scholar
  16. 16.
    Garthwaite M, Harris N. Vesicovaginal fistulae. Indian J Urol. 2010;26:253–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kapoor R, Ansari MS, Singh P, et al. Management of Vesicovaginal fistula: an experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach. Indian J Urol. 2007;23:372–6.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Latzko W. Postoperative vesicovaginal fistulas. Am J Surg. 1942;58:211–28.CrossRefGoogle Scholar
  19. 19.
    Rutman MP, Rodríguez LV, Raz S. Vesicovaginal fistula: vaginal approach. In: Raz S, Rodríguez LV, editors. Female urology. 3rd ed. Philadelphia: Saunders Elsevier; 2008. p. 794–801.CrossRefGoogle Scholar
  20. 20.
    Nardos R, Browning A, Chen CC. Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae. Am J Obstet Gynecol. 2009;200:578e1–4.CrossRefGoogle Scholar
  21. 21.
    Ockrim JL, Greenwell TJ, Foley CL, et al. A tertiary experience of vesico-vaginal and urethro-vaginal fistula repair: factors predicting success. BJU Int. 2009;103:1122–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center. Urol J. 2010;7:35–9.PubMedGoogle Scholar
  23. 23.
    Shah SJ. Laparoscopic transabdominal transvesical Vesicovaginal fistula repair. J Endourol. 2009;23:1135–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Tenggardjaja CF, Goldman HB. Advances in minimally invasive repair of vesicovaginal fistulas. Curr Urol Rep. 2013;14(3):253–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Pietersma CS, Schreuder HW, Kooistra A, et al. Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool?.BMJ Case Rep. 2014;2014. pii: bcr2014204119. doi: 10.1136/bcr-2014-204119.

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2015

Authors and Affiliations

  • Vinod Priyadarshi
    • 1
    Email author
  • Jitendra Pratap Singh
    • 1
  • Malay Kumar Bera
    • 1
  • Anup Kumar Kundu
    • 1
  • Dilip Kumar Pal
    • 1
  1. 1.Department of UrologyIPGMER and SSKM HospitalKolkataIndia

Personalised recommendations