Ureterovaginal Fistula: Experience in Veterans General Hospital-Taipei

Abstract

The experience of 20 iatrogenic ureterovaginal (UV) fistulas in 17 patients collected over a 16-year period was reviewed. The symptoms of ureteral injury appeared 1 to 20 days (mean 12) after antecedent gynecological procedure. Retrograde ureteral catheterizations were tried 11 times in 10 patients, but all failed. Of the 20 fistulas, 3 were managed successfully with percutaneous nephrostomy (PCN) drainage; 10 received end to end anastomosis of ureter or uretero-neocystostomy after initial PCN drainage; 3 refused treatment ( two fistulas healed spontaneously without ureteral stricture, one lost renal function on the lesion side kidney later); and 3 received direct ureteroneocystostomy. Percutaneous nephrostomy alone was successful as a primary therapy in 4 of 14 fistulas. These four fistulas closed uneventfully 1 to 3.4 months (mean 2.1) after PCN drainage. The other 10 fistulas required definite surgery after a period of indwelling PCN drainage (range 0.2 to 7 months, mean 2.8). Initial management with PCN may preserve renal function and provide the chance of spontaneous healing; however, many cases still require surgery later.