Retrospective analysis of management of uretero vaginal fistula

Due to anatomic proximity of urogenital organs, urinary tract injury may lead to various complications including ureterovaginal fistula (UVF). We carried out a study to evaluate the etiopathogenesis, diagnostic and therapeutic aspects of ureterovaginal fistula along with outcome. The retrospective study was conducted at a tertiary care centre of eastern India, from January 2012 to January 2017. The etiopathogenesis, clinical presentation and various investigative procedures were recorded. Therapeutic procedures used to treat ureterovaginal fistula and their results were analysed. During our study period twenty eight cases of UVF were recorded. Two cases had concomitant vesicovaginal fistula (VVF) along with UVF. Out of 28, 23 cases were post hysterectomy, while 5 were due to obstetric injuries. Ten patients were treated by laparoscopic method, 12 by open repair, and 5 by endoscopic ureteric stenting and in one case percutaneous nephrostomy (PCN) resolved the fistula. Patients who required surgery were treated by ureteroneocystostomy with or without psoas hitch. Simultaneous VVF repair was done in two patients. Post-operative voiding cystogram showed no leakage in all 22 operated patients. Postoperative intravenous urography (IVU) at three months showed patent anastomosis in all but one patient. Early diagnosis and treatment of UVF produces excellent results. Endoscopic ureteric stenting should be tried in all patients, which if successful may avoid further surgery.