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Ureterovaginal Fistula

Abnormal communication between ureter and vagina

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Ureterovaginal Fistula?

Ureterovaginal fistula is an abnormal epithelialized tract connecting the ureter to the vagina, leading to continuous urine drainage from the vagina.

Most cases (70–80 percent) result from iatrogenic injury during gynecologic surgery, particularly total abdominal or laparoscopic hysterectomy.

Other causes include obstetric trauma, pelvic radiation, advanced pelvic malignancy, endometriosis and rarely tuberculosis.

Symptoms typically appear 5–14 days after the inciting event, when devascularized tissue undergoes necrosis and the fistula tract forms.

The injury is often near the distal ureter where it crosses beneath the uterine artery, an area at high surgical risk.

Symptoms

Continuous involuntary urinary leakage from the vagina, day and night
Preserved normal voiding (distinguishing from vesicovaginal fistula where voiding may be diminished)
Vaginal urine pooling on examination
Skin irritation, dermatitis or excoriation in the vulvovaginal area
Recurrent urinary tract infections
Flank pain or fever if associated with ureteral obstruction or hydronephrosis
Psychological distress, social withdrawal due to incontinence

Risk Factors

Recent hysterectomy (most common cause, especially for malignancy or large fibroids)
Cesarean hysterectomy or complicated obstetric delivery
Pelvic radiation therapy
Advanced pelvic cancer (cervical, ovarian, endometrial) with surgery or radiation
Severe endometriosis affecting the ureter
Previous pelvic surgery with adhesions distorting anatomy
Inflammatory bowel disease with pelvic involvement

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Continuous vaginal leakage of clear fluid after pelvic surgery
  • New onset of urinary incontinence following hysterectomy
  • Watery vaginal discharge with preserved normal voiding
  • Recurrent urinary infections after recent pelvic surgery
  • Flank pain or fever after pelvic surgery
  • Vulvar skin irritation with continuous wetness

Treatment Methods

01
Confirm diagnosis: tampon test (methylene blue instilled into bladder, oral phenazopyridine for ureteral identification), CT urography, retrograde pyelography
02
Cystoscopy and bilateral retrograde pyelogram to localize the injury and assess ureteral integrity
03
Initial management: ureteral stent placement attempted endoscopically — successful in 50–70 percent of distal fistulas allowing healing without surgery
04
If stent fails or fistula persists despite drainage: surgical repair after 6–12 weeks (waiting for tissue inflammation to subside)
05
Surgical options: ureteroneocystostomy (re-implantation) with psoas hitch or Boari flap for distal injuries; ureteroureterostomy for short defects
06
Robotic or laparoscopic approach increasingly used for elective repair
07
Treat associated infections with culture-directed antibiotics
08
Skin care with barrier creams and protective garments while awaiting repair
09
Postoperative stenting for 4–6 weeks after surgical repair
10
Follow-up imaging to confirm patency and absence of stricture

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.