Urologic Fistulas

At The University of Kansas Health System, our fellowship-trained urologic surgeons, including female pelvic medicine and reconstructive surgery specialists, are experts in diagnosing and treating urologic fistulas with the most advanced and least invasive treatment options.

A urologic or urinary fistula is an abnormal connection or opening between 2 body parts that do not normally connect. This irregular opening in the urinary tract allows urine or stool to pass through areas they normally would not. Fistulas can be painless or painful and may arise spontaneously or result from disease, injury, radiation therapy or occur after a prior surgery.

Infections or inflammation can also cause urologic fistulas to form, and they can also develop because of cancer, but this is rare.

Urologic fistulas may involve multiple parts of the genitourinary system, but most commonly are associated with the bladder, prostate, ureter, urethra or vagina. Urologic fistulas can form between:

• Bladder and bowel
• Bladder or urethra and vagina
• Prostate and rectum
• Ureter and vagina
• Vagina and rectum

Common types of fistulas that affect organs in the urinary system:

• Bladder fistula is an abnormal connection between the bladder and another organ (such as the bowel or vagina) or the skin.
• Prostate-rectal fistula is an abnormal connection between the prostatic urethra and rectum and may develop after being treated for prostate cancer with open or robotic laparoscopy, radiation seed placement or cryotherapy.
• Rectovaginal fistula is an abnormal connection between the vagina and the rectum.
• Ureterovaginal fistula is an abnormal connection between a ureter and the vagina.
• Urethrovaginal fistula is an abnormal connection between the vagina and urethra.
• Urogenital fistula is an abnormal connection between the urinary tract and bladder, ureters or urethra.
• Vesicovaginal fistula is an abnormal connection between the vagina and the bladder.

Urologic fistulas are more common in women than men and symptoms can be highly variable depending on the type of fistula and the underlying cause. Noticeable symptoms in women may include:

• Fluid leaking from the vagina
• Continual leakage of urine from the vagina
• Foul-smelling gas or discharge from the vagina
• Feces leaking into the vagina

Symptoms in men and women may include:

• Persistent and/or recurrent urinary tract infections
• Passing gas from the urethra while urinating
• Urine that looks and/or smells like stool
• Abdominal pain

Some reasons fistulas develop include:

• Hysterectomy, C-section, surgery on the back wall of the vagina, perineum, anus or rectum
• Tears or infection from episiotomy incision for childbirth
• Malignancy in the pelvic region, such as colon cancer or cervical cancer
• Receiving radiation treatment for gynecologic cancer, which weakens tissue
• Crohn’s disease, colitis, inflammatory bowel disease or diverticulitis

Your physician will perform a thorough examination, including imaging, which is often needed to diagnose a fistula and help guide surgical treatment options. Your surgeon will decide which imaging or procedure is best for your individual case.

Our multidisciplinary team approach to diagnosis and treatment of urologic fistulas may involve specialists from female pelvic medicine, oncology and/or urologic reconstructive surgery. Urologic fistula treatment is generally managed by surgeons. Fistulas can occur anywhere in the body, so the organs involved in your fistula determine the surgical specialists who will care for you.

This type of integrated care is often needed for the successful treatment of urologic fistulae, which can be difficult to manage and often require complex surgeries involving more than one type of surgeon. The goal is to restore the normal connections of the organs and correct the underlying cause of the fistula.

If you’ve been diagnosed with a urologic fistula, our urologic specialists will determine the best plan of treatment based on its location, size and condition. Some simple fistulas may require only conservative treatment, but most will need surgical repair.

As part of the only academic medical center in Kansas, we have the urologic surgical specialists available to provide individualized care for this complex condition. We use the latest techniques and, when appropriate, minimally invasive surgical options to help patients recover faster from repair of urologic fistulas.

The type and location of the fistula will determine the surgical method we employ – typically laparoscopic surgery, with small incisions, or robot-assisted surgery involving very precise movements. Some surgeries are done through the vagina, and some through the abdomen.

Robot-assisted surgery at The University of Kansas Health System is recognized as a program of excellence and offers the most advanced and comprehensive program within 500 miles. We have the most robots, most robotic specialties and most robotic surgery treatments that lead to improved outcomes for our patients.