The ureterovaginal fistula is an abnormal passage between the ureter and vagina.
A woman with a ureterovaginal fistula develops continuous urinary incontinence and possibly fever, chills, malaise, and flank pain. These symptoms manifest 2 to 4 weeks after gynecological surgery . The urinary incontinence resembles the profile of stress incontinence.
On pelvic examination, there is evidence of vaginal pooling of clear fluid. A mature fistula is observed as a tiny opening at the vaginal apex, however, the opening is not as apparent in an immature fistula. The latter is characterized by inflammation of the vaginal mucosa. Furthermore, granulation tissue along the fistula is another clinical finding.
The clinical assessment consists of the patient's history, physical exam, and the relevant studies. If the patient is intolerant to the pelvic exam, anesthesia should be considered.
The workup should include a complete blood count (CBC), urinalysis, urine culture, and a complete metabolic panel. If the in doubt, confirmation is attained by measuring the fluid's creatinine level, which should be slightly greater than that of plasma creatinine for the fluid to be urine.
Investigation studies such as intravenous pyelography (IVP) or computed tomography urography are obtained to evaluate the genitourinary tract. Abnormal results on IVP should warrant further testing with retrograde pyelography, which confirms this diagnosis.
Other procedures may include cystography and the double dye test.
Early surgical repair is the therapy of choice in many women. The surgeon will use his/her approach based on expertise and preference. The repair can be performed through minimally invasive techniques such as laparoscopy and robotic surgery , which are associated with shorter hospital stays and decreased morbidity .
Preoperative treatment with conjugated estrogen can soften the vaginal tissue, especially in women with atrophic vaginitis . Also, some clinicians will place catheter drainage of small fistulae for 4 to 6 weeks in an attempt to heal the condition.
Ureterovaginal fistula repair yields excellent results, especially when performed by experienced and skilled surgeons. The initial procedure is typically more successful than further attempts.
Most cases of ureterovaginal fistulae arise from ureteral injuries sustained during pelvic surgery  while others stem from devastating vaginal deliveries. Another cause of fistulae is radiation to the pelvis, although this type develops a month to years later.
While the majority of ureterovaginal fistulae in the United States and other developed countries are attributed to hysterectomy procedures , complicated childbirth is the leading cause in developing regions .
During female pelvic surgery, the ureter is prone to injury especially during dissection of nearby tissue or an iatrogenic error involving the ureter or its vasculature . This damage will cause ischemia, necrosis, and eventually the formation of this anatomical defect. Additionally, vaginal deliveries with obstructed and long-standing labor can cause injury to the vaginal mucosa and lead to fistula formation. Note that a ureterovaginal fistula is often accompanied by a vesicovaginal fistula  .
Surgeons should take precautions while operating to prevent the formation of an iatrogenic ureterovaginal fistula.
The ureterovaginal fistula is a communication tract between the distal ureter and vagina that emerges as a complication of gynecological surgery or obstetric trauma. This condition is diagnosed by the clinical presentation, history, pelvic exam, and imaging studies. Prompt recognition and surgical repair can result in good outcomes.
The ureterovaginal fistula is a connection between the ureter and the vagina. This type of fistula forms when there are complications in gynecological surgery (such as hysterectomy) or after difficult childbirth. The symptoms include urine incontinence, fever, chills, and malaise. This is diagnosed through the history, pelvic exam, and imaging studies. Treatment is early surgical repair of the fistula.