What is a urologic fistula?
A urologic fistula is an abnormal channel between the urinary tract and an adjacent organ or the skin surface — allowing urine, gas, or feces to pass where they should not. Fistulae may form after surgery, radiation, trauma, infection, or inflammatory bowel disease.
Symptoms range from continuous urinary leakage from the vagina to pneumaturia (air in the urine) or fecaluria, depending on the fistula type. The diagnosis can be straightforward or require a thorough investigative workup. Treatment is almost always surgical, and the approach must be tailored to the cause, location, tissue quality, and prior treatment history — particularly in patients who have received pelvic radiation.
Vesicovaginal (VVF)
Between the bladder and vagina. Most common urologic fistula in women. Often follows hysterectomy or pelvic surgery.
Urethrorectal / Rectourethral
Between the urethra and rectum in men. Often follows prostate surgery or radiation. Complex repair requiring tissue interposition.
Colovesical
Between the colon and bladder, often from diverticulitis or Crohn's disease. Presents with pneumaturia and fecaluria.
Ureterovaginal
Between the ureter and vagina, typically following gynecologic surgery with inadvertent ureteral injury.
How fistulae are evaluated
Establishing the exact location, size, cause, and tissue environment of a fistula is essential before any repair is planned. This is especially important in radiation-associated fistulae, where tissue quality and vascularity significantly affect surgical options and outcomes.
Cystoscopy
Direct visualization of the bladder and urethra to identify fistula location, assess mucosa quality, and evaluate for concurrent pathology.
Contrast Studies (VCUG / RUG)
Fluoroscopic studies that can demonstrate fistula tracts and confirm communication between structures.
MRI Pelvis
High-resolution soft tissue imaging particularly useful for complex, radiation-associated, or multiply operated fistulae where anatomy is distorted.
CT Urogram / CT Abdomen-Pelvis
Cross-sectional imaging to evaluate the full urinary tract, identify colovesical fistulae, assess for abscess or fluid collections, and rule out malignancy.
Colonoscopy / Vaginoscopy
Endoscopic evaluation of adjacent structures when bowel or vaginal involvement needs direct assessment.
Surgical repair
The vast majority of urologic fistulae require surgical repair. The choice of approach — open, robotic, vaginal, transperineal, or transabdominal — depends on the fistula type, cause, tissue quality, and prior surgical history.
Vesicovaginal Fistula Repair
VVF repair can be performed transvaginally or transabdominally (open or robotic) depending on the fistula's location, size, and prior repair history. The Latzko technique is commonly used for small, apical fistulae following hysterectomy. Larger or recurrent fistulae, and those in irradiated tissue, often require tissue interposition with a labial fat pad (Martius flap) or omental pedicle to bring healthy vascularized tissue into the repair.
Dr. Wiegand has performed VVF repair at time of colpocleisis and has extensive experience with robotic-assisted transabdominal approaches for complex cases.
Rectourethral Fistula Repair
Rectourethral fistulae are among the most technically demanding repairs in reconstructive urology. They most commonly follow radical prostatectomy or radiation for prostate cancer. Repair requires fecal diversion (colostomy) as a first step in most cases, followed by transperineal or transabdominal fistula closure with gracilis muscle interposition or omental flap to provide a vascularized tissue barrier between the urethra and rectum.
Radiation history significantly affects tissue quality and healing potential — these cases require careful preoperative planning and appropriate staging of repair.
Colovesical Fistula Repair
Colovesical fistulae from diverticulitis typically require sigmoid colectomy with colostomy or primary anastomosis, combined with bladder closure. These are often coordinated with colorectal surgery. Dr. Wiegand manages the urological component of these repairs and coordinates multi-specialty care as needed.
Radiation-Associated Fistulae
Fistulae occurring in previously irradiated tissue represent a particular challenge. Radiation damages vascularity and tissue healing capacity, making standard primary repairs much more likely to fail. These cases nearly always require vascularized tissue interposition — bringing in healthy, non-irradiated tissue from outside the radiation field — to achieve durable closure.
Hyperbaric oxygen therapy may be considered as an adjunct to improve tissue oxygenation prior to repair. Timing and staging of repair must account for the degree of radiation injury and the patient's overall healing capacity.
Complex cases welcome
Dr. Wiegand regularly accepts referrals for recurrent, radiation-associated, and previously failed fistula repairs. If you've been told your fistula is not fixable or that repair carries too high a risk, a second opinion consultation is worthwhile.
Dealing with a urologic fistula?
Dr. Wiegand has extensive experience with complex fistula repair including radiation-associated and recurrent cases. Request a consultation.
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