A bladder fistula is when an opening forms between the bladder and some other organ or the skin. Most often the bladder opens to the bowel (“enterovesical fistula”) or the vagina (“vesicovaginal fistula”).
How Does the Bladder Usually Work?
The bladder is a balloon-shaped organ that stores urine, which is made in the kidneys. It is held in place by pelvic muscles in the lower part of your belly. When it isn’t full, the bladder is relaxed. Nerve signals in your brain let you know that your bladder is getting full. Then you feel the need to pee. The brain tells the bladder muscles to squeeze (or “contract”).
Causes
Though rare, a bladder fistula to the skin can result when the bladder outlet is blocked and the bladder is damaged. This can be due to injury or prior surgery. Vesicovaginal fistulas can be seen after a urological or gynecological surgery. They can also be linked to gynecological cancers. Fistulas to the bowel are mostly a result of a disease that causes inflammation, such as Crohn’s disease or diverticulitis. About 2 out of 10 cases of bowel fistula are caused by bowel cancer. Fistulas to both the vagina and the bowel may also form as a result of radiation therapy.
Symptoms
Your health care provider may suspect bladder fistula if you have difficult urinary tract infections. Other signs are urine smelling or looking like stool or if gas comes out through your urethra when you pee.
Diagnosis
Bladder fistula is diagnosed with an x-ray study. The type of x-ray used may be a CT scan or a pelvic x-ray. A dye that shows up well in x-rays (called “contrast”) will be put into your bladder, either through a vein or a catheter. Your health care provider may also look into your bladder with a cystoscope, a long, thin telescope with a light at the end. In some cases, x-ray studies with contrast may be done on other organs (like the bowel), as well.
Treatment
We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Bladder fistula is most often treated with surgery to remove the damaged part of the bladder. Healthy tissue is moved between the bladder and the other organ to block the opening. If the fistula is caused by a disease, such as colon cancer or inflammatory disease, the fistula is fixed during the surgery to treat that disease.
After Treatment
The success of the surgery depends on the surgeon being able to remove the main disease. There also must be healthy tissue to close the fistula with. If there is cancer that can’t be removed or tissue that has poor blood flow due to radiation treatment, the results might not be as good. After surgery, you can expect to have a catheter in your bladder for a few weeks.