Ureterovaginal fistulas: The role of endoscopy and a percutaneous approach

PURPOSE: The aim of the study was to evaluate the minimal invasive approach and endourological techniques in managing the iatrogenic ureterovaginal fistula. The etiology and the diagnostic tools were also looked at. PATIENTS AND METHODS: A retrospective study was conducted on 20 patients with ureterovaginal fistulas. The main causes for these were gynecological and obstetrical procedures. In all cases, the diagnosis was based on clinical presentation, intravenous pyelography, and cystoscopy. Various therapeutic methods were used. Eleven patients were treated by the endoscopic placement of a ureteral stent and 13 patients (including four with failed initial ureteral stent insertion) received ureteral reimplantation. Of these, two patients were treated by the Boari flap method, six by Psoas hitch, four by simple ureteric reimplant, and one by transureteroureterostomy. RESULTS: Of the 11 patients treated by the endoscopic placement of a ureteral stent, 7 (64%) were successfully managed with this treatment alone. The remaining 4 (36%) also had open surgery. A total of 13 patients (including the 4 initially treated with endoscopic placement) underwent successful ureteric reimplantation. Routine cystoscopy revealed that 2 of the 20 patients (10%) had a concurrent vesicovaginal fistula. CONCLUSION: A ureterovaginal fistula is a rare but a relatively frequent complication of pelvic surgery. We recommend a minimal invasive approach including ureteric stent insertion as primary management and routine cystoscopy to rule out an association of a vesicovaginal fistula.