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Clin Colon Rectal Surg 2003; 16(1): 039-050
DOI: 10.1055/s-2003-39036
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Genitourinary Fistulae

O. Lenaine Westney1 , Peter O. Kwong1 , Edward J. McGuire2
  • 1Division of Urology, University of Texas Health Science Center at Houston and University of Texas M.D. Anderson Cancer Center, Houston, Texas
  • 2Department of Urology, University of Michigan, Ann Arbor, Michigan
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Publication History

Publication Date:
07 May 2003 (online)

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ABSTRACT

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.

KEYWORDS

Vesicovaginal - ureterovaginal - ureterovesical - ureteroiliac - fistula

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