Pelvic fistulae are an abnormal communication among the genitourinary tract, the gastrointestinal tract, and the vagina or perineum. Genital tract fistulae have been described in the medical literature for the past several thousand years. Advancements in both the diagnosis and treatment of vaginal fistulae have been obtained over the past century as surgical interventions have become safer and surgical techniques have improved. The most common cause of fistulae worldwide is obstructed labor. In developed countries, fistulae most commonly occur after benign gynecologic surgery, but obstructed labor, malignancy, radiation exposure, and inflammatory bowel disease can also cause fistulae. Fistulae significantly affect quality of life. Diagnostic studies and radiologic imaging can help aid the diagnosis, but a thorough physical examination is the most important component in the evaluation and diagnosis of a fistula. Temporizing treatments are available to help ease patient suffering until surgical management can be performed. Surgical repairs can be performed using an abdominal, vaginal, or transanal approach. Although technically challenging, surgical repair is usually successful, but closure of the fistula tract does not guarantee continence of urine or feces, because there is often underlying damage to the bowel and bladder.
Supplemental Digital Content is Available in the Text.A review of the evaluation and treatment of vaginal fistulae is presented.
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico.
Corresponding author: Rebecca G. Rogers, MD, Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM 87131; e-mail: firstname.lastname@example.org.
Financial Disclosure Dr. Rogers serves on the Data and Safety Monitoring Board for the TRANSFORM trial sponsored by ASTORA; she receives royalties from UpToDate and McGraw Hill for scientific writing. The other author did not report any potential conflicts of interest.
Continuing medical education for this article is available at http://links.lww.com/AOG/A835.