Urethrovaginal Fistula

Etiology and Presentation

In the industrialized world, urethrovaginal fistula most commonly occurs as a result of transvaginal surgery, including anti-incontinence surgeries, anterior vaginal wall prolapse repair, and urethral diverticulectomy.43-46 Pelvic radiation, trauma, including pelvic fracture, and vaginal and urethral neoplasms are less common causes of urethrovaginal fistula. In female patients with long-term indwelling urethral catheters and cognitive or sensory impairments, pressure necrosis may cause a traumatic hypospadias and urethrovaginal fistula. In nonindustrialized nations, obstructed labor is the most common etiology of urethrovaginal fistula, usually with concomitant VVF.47

Symptoms of urethrovaginal fistula are dependent on the size of the fistula, and the

location relative to the urethral sphincter. Large fistulas are more likely to present with continuous large volume incontinence, and small fistulas may produce only a small amount of leakage. Fistulas proximal to the urethral sphincter mechanism, either in the proximal urethra or at the bladder neck, can present with continuous incontinence, similar to VVF. Distal urethrovaginal fistulas, distal to the sphincter, can be asymptomatic or present with a splayed urinary stream. Occasionally, patients will present with vaginal voiding or “pseudo-incontinence,” due to accumulation of urine within the vaginal vault. These patients will leak when rising from a seated position after voiding.

Diagnosis and Management

The diagnosis of urethrovaginal fistula can be made based on history, physical exam, and cystourethroscopy, but radiologic imaging can also