Urogenital Fistulas and Female Urethral Diverticula

Urogenital fistulas are a group of conditions in which the urinary tract is apparently connected to another organ system. Causes of fistula range from congenital anomalies, malignancy, trauma, infection or inflammatory conditions, ischemia, parturition, and iatrogenic sources – including surgery and radiation. Signs and symptoms of urinary tract fistula are variable and depend on the organ system involved and the size of the fistula. For patients who are appropriate surgical candidates, elective surgical repair is the mainstay of treatment of urinary tract fistula. Surgical techniques can be complex, but rely on the same key concepts: adequate exposure of the fistula tract; careful dissection and separation of the tissue layers, while minimizing cautery; multi-layer closure; watertight closure of each layer; meticulous hemostasis to prevent hematoma formation, but preserve vascular supply of tissues; use of well-vascularized tissue flaps; tension-free, non-overlapping suture lines; biopsy of tissues concerning for malignancy. This review contains 6 figures, 5 tables, and 82 references. Keywords: urogenital fistula, female bladder, vesical fistula, urinary bladder fistula, vesicovaginal fistula, urethrovaginal fistula, vaginal fistula, urethral diverticulum, urethral diverticulectomy, female urethra