Ureterovaginal Fistula Causes and Management

Main Causes

The primary cause of ureterovaginal fistula is iatrogenic injury during pelvic surgery, particularly gynecological procedures such as hysterectomy, where an initially unrecognized ureteral injury can present in a delayed manner as a ureterovaginal fistula 1, 2
Obstetric/vaginal trauma accounts for a significant portion of cases, with similar mechanisms leading to ureterovaginal fistulas 3
Penetrating pelvic trauma can directly damage the ureter and lead to fistula formation 1
Radiation therapy for gynecological malignancies can cause tissue damage leading to fistula formation 3, 4
Pelvic malignancies can invade the ureter and vagina, creating a pathological connection 3

CT with intravenous contrast and delayed imaging is currently the most common method for evaluating urinary extravasation 5
Water-soluble contrast may be used to opacify fistulous tracts 3

According to the American Urological Association (AUA) guidelines, patients with ureterovaginal fistula should be initially managed with ureteral stent placement when possible 1
Ureteral stenting has become the first-line treatment in uncomplicated ureterovaginal fistulas, with success rates of 64-100% 1
Transureteroureterostomy may be recommended in cases of stent failure 1
Surgical approaches may be open, laparoscopic, or robot-assisted, with success rates approaching 100% for reimplantation procedures 1

Early recognition of ureteral injury during pelvic surgery is crucial to prevent fistula formation 2
Preventive measures during pelvic surgery, including careful identification of ureters, can significantly reduce the risk of this complication 2