Editing Functional: Urinary Fistulae (section)

=== Urethrovaginal fistula ===

==== Causes ====
* In industrialized countries, urethrovaginal fistulae in adults mostly have an iatrogenic cause.
** Hysterectomy is not associated with formation of urethrovaginal fistula.
* In the developing world, urethrovaginal fistula may occur as a result of obstructed labor with or without associated VVF.

==== Diagnosis and Evaluation ====
* '''Symptoms of urethrovaginal fistulae are largely dependent on the size and location of the fistula along the urethral lumen'''
** '''Proximal fistulae can be associated with stress incontinence, or, if they are located at the bladder neck, continuous incontinence may result, similar to that associated with VVF'''
** '''Distal fistulae beyond the sphincteric mechanism may be completely asymptomatic or may be associated with a splayed urinary stream.'''
* '''Can often be made on physical examination and cystourethroscopy; however, VCUG is most useful'''
* '''An associated VVF will be found in up to 20% of cases, and therefore a thorough evaluation of the entire lower urinary tract is warranted'''

==== Management ====
* Foreign material should be excised as widely as possible from the margins of the fistula
* Various types of soft-tissue flaps are often an important component of a successful urethrovaginal fistula repair including, most commonly, a Martius labial fat flap, but also gracilis and rectus abdominis muscle
* SUI may persist after repair of urethrovaginal fistulae. Whether repair of SUI should be done concomitantly with the fistula surgery or should be deferred until after repair of the fistula is controversial