DISORDER OF URINARY BLADDER – Bladder Fistula (Etiology, Clinical Manifestations, Diagnostic Evaluations and Management)

DISORDER OF URINARY BLADDER – Bladder Fistula

(Etiology, Clinical Manifestations, Diagnostic Evaluations and Management

 
BLADDER FISTULA

Bladder fistula refers to an abnormal connection between the bladder and another organ or the skin. Most commonly this involves the bowel (enterovesical fistula) or the vagina (vesicovaginal fistula). Although relatively rare, fistulization to the skin can result from an injury or previous surgery in the face of bladder outlet obstruction. Vesicovaginal fistulas are seen after a urologic or gynecological surgery or in relation to gynecological cancers. Fistulas to the bowel are most commonly seen as a result of inflammatory bowel disease such as Crohn’s disease or diverticulitis. About 20 percent of bowel fistulas are caused by bowel cancer. Fistulas are rarely caused by bladder pathology. Fistulas to both the vagina and the bowel may also develop as a result of previous radiation therapy.

ETIOLOGY

There are many factors that can lead to the development of bladder fistulas. One of them is injury that occurs during surgical treatment of the urinary system or the reproductive system. Sometimes, people develop fistulas as a complication of inflammatory bowel disease, and some develop them as a complication of bowel cancer. An individual may even develop a bladder fistula after having radiation therapy.

CLINICAL MANIFESTATIONS

One of the symptoms of a bladder fistula is acute urine leakage that doesn’t appear to be connected to any other type of condition. A person with this condition may also note the frequent development of urinary tract infections, have gas escape from the urethra during urination, or feel urine leaking out of the vagina instead of coming from the urethra. In some cases, a person with this condition may also notice urine on the surface of his skin or feces in his urine. Additionally, a person who has a bladder fistula may develop a fever, notice skin irritation, or have discomfort that is related to the condition.

 

DIAGNOSTIC EVALUATION

Bladder fistula is diagnosed by the use of a CT scan, cystogram (bladder x-ray), or an excretory urogram, which is an X-ray examination of the kidneys and bladder. An excretory urogram study uses a contrast dye to enhance the X-ray images. The dye is injected into the patient’s system and its progress through the urinary tract is then recorded on a series of quickly captured images. The examination enables the radiologist to review the anatomy and the function of the bladder and urinary tract.

 

MANAGEMENT

Treatment for a bladder fistula usually involves surgery, though it may be necessary to treat any abscesses or infections the patient has before moving on with surgical treatment. Once such conditions have been treated, surgeons usually aim to repair the abnormal holes in the patient’s organs and may use healthy tissues to create a new barrier between the bladder and the other affected body structures. If it is caused by a disease such as colon cancer or inflammatory disease, surgical removal is usually done in conjunction with removal of the primary disease. If there is cancerous tissue present, surgeons may also remove that tissue as part of the surgery. If this is not done the bladder fistula tends to grow back again at the same place where it has previously occurred. The success of surgery is directly related to the ability to remove the primary disease and the presence of healthy tissue with which the fistula is closed.