• Urovascular Fistula
  • General considerations:
    • Most commonly, these fistulae occur between the ureter and surrounding blood vessels such as the iliacs.
    • Presentation:
      • Vigorous hematuria in the setting of indwelling stents
        • In a previously irradiated patient
        • A patient with a history of vascular surgery
    • Management:
      • Immediate surgical intervention is indicated if the patient is in extremis (exsanguinating, etc.),
      • If the patient is stable, imaging studies including CT, MRI, or angiography may be indicated.
        • In some cases, surgery can be avoided with the use of interventional radiological techniques.
• Vesicouterine Fistula
  • Etiology
    • Most commonly occur following low segment cesarean section.
  • Presentation:
    • Classically described as Youssef's syndrome:
      • Menouria,
      • Apparent amenorrhea,
      • Patent cervix,
      • Urinary continence.
    • Urinary incontinence
    • Infertility
  • Treatment
    • Usually surgical
      • Hysterectomy and closure of the bladder (if the patient has completed child-bearing)
      • Excision of the fistula tract and separate closure of the bladder and uterus with interposition of omentum.
    • Occasionally, successful treatment has been seen with hormonal induction of amenorrhea and catheter drainage.

References

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