Log in
Obstetrics and Gynecology · Gynecology

Urogenital fistulas

*Fistulae urogenitales*

Urogenital fistulas are pathological communications between the organs of the urogenital system or adjacent structures (intestines). This condition requires thorough diagnosis and, as a rule, surgical intervention to restore the anatomical integrity of the organs.

Ask the AI
Key methodSurgical treatment is the only radical way to correct fistulas.
Main symptomInvoluntary leakage of urine from the vagina in vesicogenital fistulas.
DiagnosticsA complex of methods: from fistulography to CT and MRI to assess the depth of destruction.
Cause #1Pelvic inflammatory processes leading to abscess perforation.
2 min readFor medical studentsUpdated Sep 25, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Classification and etiology

Fistulas are classified according to the involved organs and the mechanism of occurrence:

  1. Vesicogenital: include vesicouterine and vesicovaginal communications.
  2. Ureterogenital and urethrovaginal fistulas.
  3. Combined: a combination of urogenital and urinocolic defects.

The main causes are obstetric and gynecological surgeries, birth trauma, and complications of pelvic inflammatory disease. In recent years, cases of thermal/burn fistulas associated with the use of laparoscopic access have become more frequent.

Clinical features

The course of inflammatory fistulas is often recurrent. There are three stages:

  • Perforation: an acute condition with fever, pain, and purulent discharge.
  • Apparent improvement: after the abscess ruptures into a hollow organ, the patient's condition temporarily stabilizes.
  • Relapse: due to incomplete drainage of the abscess and rapid obliteration of the fistula, the process repeats.

In traumatic vesicovaginal fistulas, the key symptom is constant urinary leakage. The time of onset of complaints varies from the first 24 hours (direct trauma) to 7–11 days (trophic disorders).

Test your knowledge on this topicTasks from the "Obstetrics and Gynecology" course bank — immediate answers and explanations.

Principles of treatment

Surgical tactics for combined lesions require strict adherence to staging:

StepAction
Stage IRestoration of intestinal integrity
Stage IIGynecological intervention

Intestinal repair is performed first to prevent pelvic infection. The scope of the gynecological surgery depends on the degree of tissue destruction, the patient's age, and the nature of the underlying disease.

Briefly: answers to topical questions

What instrumental methods are used for the comprehensive diagnosis of urogenital fistulas?

The following instrumental methods are used to diagnose urogenital fistulas:

  • Double endoscopy — used to detect urethro- and vesicovaginal fistulas. One endoscope is inserted into the urethra, and the second — through a cystostomy into the urinary bladder.
  • Cystourethrography — allows the detection of urogenital fistulas, a decrease in bladder capacity, bladder deformation, and vesicoureteral reflux.
  • Cystourethroscopy — the most informative method for detecting urinary tract strictures.

What conservative measures are used at the stage of preparation for surgical fistula closure?

The sources do not describe measures used strictly at the preoperative stage. Conservative therapy includes:

  • Vaginal tampons.
  • Local vaginal sanitation.
  • General strengthening therapy.
  • Immunostimulatory therapy.

Spontaneous closure of the fistula is possible. If conservative therapy is ineffective, surgical treatment is indicated, which is performed by colorectal surgeons.

How to memorize

A fistula is an "abnormal tract". Remember: in case of inflammation, treat the bowel first to avoid "seeding" the pelvis with infection before the gynecological stage.

Class and exam questions

Why might a patient's condition suddenly improve in inflammatory fistulas?

This occurs during the stage of abscess rupture into a hollow organ, when purulent contents are evacuated, which temporarily reduces intoxication and pain syndrome.

Does urine always leak constantly in case of a fistula?

No, in pinpoint fistulas or those located high up, spontaneous urination may persist.

Can a fistula be cured conservatively?

Spontaneous closure is possible only in rare cases; in most situations, elective surgical treatment is indicated.

Something unclear? Ask the AIThe AI tutor has read the material on "Urogenital fistulas" and will explain it in simple terms.

What else to study on this topic

  • Differential diagnosis of fistulas with other urinary tract pathologies.
  • Features of preoperative preparation in purulent processes.
  • Technical nuances of fistulography in complex anatomical defects.
  • Psychological rehabilitation of patients with chronic urinary leakage.
  • Prevention of obstetric trauma as a method of reducing the incidence of fistulas.

Master the entire topic in the "Obstetrics and Gynecology" course

This is a summary. The course covers everything tested in classes and exams.

  • Complete study guide on "Urogenital fistulas" and another 973 pages of the subject
  • Assignments and quizzes after every topic — just like in a colloquium
  • AI tutor answers questions on the topic anytime
  • 21 video lessons on the subject
Open full reviewSubject curriculumfrom 599 ₽ per month

Other topics in the "Gynecology" section

Genital fistulasRectovaginal fistulasTreatment of genital fistulasInflammatory diseases in gynecology

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.