Genitourinary fistulae

Genitourinary tract fistulae are primarily iatrogenic and result from a wide range of pelvic surgical procedures. The addition of radiation therapy increases the likelihood of the fistula development and complicates corrective management. Each type of fistula has signs and symptoms that suggest the diagnosis. However, the evaluation combines radiological and endourological tests to properly assess the fistula before progressing to definitive management. Uterovaginal fistulae are the most amenable to a trial of conservative therapy. The management of isolated ureterovaginal fistulae has been altered with the development of endourologic tools such as indwelling ureteral stents. The vast majority of vesicovaginal fistulae require surgical management because of the unremitting vaginal leakage of urine. Determination of the specific approach is dependent on the fistula etiology and any coexistent pathology. The suspicion of a ureteroiliac fistula warrants aggressive investigation and intervention. The vascular component of the fistula must be managed on the basis of the state of the lower extremity vasculature.