Editing Functional: Urinary Fistulae (section)

==== Diagnosis and Evaluation ====

* '''History and Physical Exam'''
** '''<span style="color:#ff0000">Most common presenting symptom is the onset of constant urinary incontinence 1-4 weeks after surgery.</span>'''
** '''<span style="color:#ff0000">In direct contrast to VVF, in the setting of continuous urine leakage from a ureterovaginal fistula, patients will continue to report normal voiding habits because bladder filling is maintained from the contralateral, presumably undamaged, upper urinary tract</span>'''

* '''Imaging'''
** '''<span style="color:#ff0000">Suspicion of a ureterovaginal fistula should prompt upper tract imaging</span>'''
*** Ureterovaginal fistulae may be seen on CT urography or MRI.
*** '''CT urogram most commonly will demonstrate some degree of ureteral obstruction and associated caliectasis or ureteral dilation. These findings in the presence of constant vaginal drainage strongly suggest a ureterovaginal fistula.'''
**** Alternatively, if the fistula is mature and large, the upper urinary tract may appear completely unremarkable; however, urine will be seen opacifying the vagina before the postvoid image.
*** If '''retrograde pyelography''' demonstrates the fistula, as well as ureteral continuity, then an attempt at stenting is warranted.
*** '''Cystography is performed primarily to exclude a coexistent VVF.'''
**** A cystogram will not demonstrate the ureterovaginal fistula unless there is preexisting vesicoureteral reflux.