Bladder Fistulas and Their Treatment - An Overview

Introduction

A fistula is an opening between body parts that are generally not joined. It can occur between any organs or anywhere in the body. Living with a fistula can be physically and psychologically demanding. The condition's symptoms can differ depending on the parts of the body affected.

What Is Bladder Fistula?

Usually, the digestive and urinary systems are separated into two different systems. When a connection develops between the bladder and another organ, it is called a bladder fistula. Bladder fistulas are very rare. Most commonly, it is seen between the vagina or the bowel. Eventually, there can be a leak from the bladder to the other connected organ. Although they cannot heal independently, bladder fistulas can be prevented and treated.

What Are the Types of Bladder Fistula?

There are many types of bladder fistulas. The most common types include:

• Colovesical Fistulas: This is the most common type of bladder fistula and occurs between the bladder and the bowel. This occurs most commonly among males.

• Enterovesical Fistulas: These occur between the vagina and the bowel. It is also called vesicoenteric fistula or intestinovesical fistula.

• Ureterovaginal Fistula: It is a type of fistula occurring between the ureter and the vagina. This type of fistula occurs only among women.

• Vesicovaginal Fistula: This type of fistula occurs only in women and connects the vaginal and bladder.

What Are the Symptoms of Bladder Fistula?

The symptoms of the bladder fistula may depend upon the organs connected. However, the common symptoms seen can include:

• Pain while urinating (dysuria).

• Abdominal pain.

• Foul-smelling urine.

• Urinal incontinence.

• Sores or infections in the genital area.

• Pyelonephritis (when the urinary tract infection spreads to the kidneys).

• Pain during sexual intercourse.

• Recurrent sepsis.

• Inability to empty the bladder.

• Recurrent urinary tract infections.

• Vaginal discharges that are not normal.

• Bubbles in urine.

• Urine appears to be muddy or clouded.

• Urge to pass urine very frequently.

• Lack of appetite.

• Changes in bowel habits.

• Unexplained weight loss.

What Are the Causes of Bladder Fistula?

Rarely, when the bladder is damaged and the bladder outlet becomes closed, there can be a bladder fistula to the skin. This can be caused by an injury or a surgery done previously. Vesicovaginal fistulas can be a result of surgery performed in the urinary tract or the genitals. It can also have an association with gynecologic cancers (cancers occurring in women). Conditions like Crohn's disease ( a chronic condition that causes inflammation of the lining of the digestive system), diverticulitis (inflammation or infection involving small pouches in the digestive tract), etc can be a reason for bladder fistulas involving the bowel. Studies show that two out of ten cases of bowel fistulas could be due to cancers involving the bowel. Another cause for fistulas associating the bowels or the vagina can be radiation therapy.

How Is Bladder Fistula Diagnosed?

Sometimes, bladder fistulas are diagnosed during an annual gynecological examination. Most often, patients consult healthcare providers for unusual symptoms. A physical examination or an imaging study helps them to find the condition. The most often requested tests are a pelvic X-ray or a CT (Computed Tomography) scan using dye or contrast. The dye or contrast is injected through a vein in the bladder. This helps the healthcare professional to visualize the origin of the fistula. Blood tests might be required in case of a urinary tract infection. In some cases, the physician might examine the bladder using a cystoscope (a long tube that helps the health care professional to view the bladder and urethra).

How Is Bladder Fistula Treated?

Surgery is the most common and reliable method to treat a fistula. In some cases, catheter drainage may be attempted when the fistula is diagnosed in its early stages. However, it may not always be successful. Surgery for bladder fistula involves the removal of the damaged part of the bladder, and placing a normal tissue between the bladder and the other organ, thereby closing the communication. Any other issues, such as organ damage, infection, edema (swelling), scar tissue, and poor blood supply, found during surgery are also corrected. Surgeries for fistula are usually very successful. However, if the fistula occurs due to cancer, its success rate can be compromised. A bladder catheter is retained in the bladder for several weeks following surgery, allowing the surgical site to recover. Antibiotics and other medication might be given to prevent infection and to promote healing.

A procedure called fistulotomy is done in mild cases. It is a procedure where the fistula is opened to remove the damaged tissue and repaired with sutures. It is a simple procedure and might last an hour. More severe cases might require another procedure called fistulectomy. In this procedure, the entire fistula and the affected parts of the other organs are removed.

Studies show that a single surgery would be sufficient in most cases of enterovesical or colovesical fistulas. Dissolvable sutures are placed to repair the irregular connection. More intensive treatment might be required in fistulas arising due to malignancies. The ability of the surgeon to eradicate the primary illness determines the procedure's outcome. In addition, the fistula needs to be sealed with healthy tissue.

The healthcare professional rarely suggests nonsurgical methods to treat the fistula. They can include:

• Treating the underlying conditions like Crohn's disease.

• Treating urinary tract infections or other underlying infections using antibiotics.

• Mild cases might be attempted to treat using fibrin glue and other similar non-invasive methods.

• Using vaginal electrocoagulation to repair the irregular vaginal mucosal layer with an electric current in minor vesicovaginal fistula.

Conclusion

An abnormality in the connection between the bladder and another organ, such as the colon, bowel, or vagina, is frequently the result of surgery or infection that leads to bladder fistulas. Gas that travels down the urethra, causing bubbles in urine, recurrent UTIs, and urine that smells or looks like stool, are common signs of bladder fistulas. There may also be changes in bowel habits, stomach pain, or unexplained weight loss.