Thông báo
CẢM ƠN QUÝ KHÁCH ĐÃ ĐẶT LỊCH KHÁM TẠI AIH.
Quý khách có muốn đăng ký thông tin trước không?
Vui lòng điền vào thông tin bên dưới
Khẩn cấp
URINARY FISTULA – AN UNSPOKEN DISEASE SERIOUSLY AFFECTING THE QUALITY OF LIFE
Urinary fistula is a condition that occurs when an abnormal passage (fistula) connects the urethra, bladder, or ureter with another organ such as the intestine, vagina, skin, or other cavities, leading to urine leakage outside its normal pathway. Although not dangerous, this condition significantly impacts the patient's health and quality of life. Early diagnosis, accurate identification of the location and cause, along with appropriate treatment options (including both conservative and surgical approaches), are crucial for optimizing outcomes.
Classification
Urinary fistulas are classified according to:
1. By connection site (involved organs):
Vesicovaginal (bladder → vagina)
Ureterovaginal (ureter → vagina)
Urethrovaginal (urethra → vagina)
Fistula between the bladder and the intestine or other parts of the digestive system (vesicoenteric) — typically the large or small intestine, depending on location
Fistula to the skin or to external cavities depending on trauma, surgery, or infection.
2. By time of onset: congenital or acquired
Congenital: For example, in gastrointestinal-urinary tract malformations (anorectal malformation), there may be a entero-urethral fistula.
Acquired: Due to surgery, childbirth, trauma, infection, radiation, chronic inflammatory diseases such as Crohn's disease.
3. By size and extent of tissue damage: small and large; presence or absence of infection/necrotic tissue; presence or absence of fibrosis, radiation-induced deep tissue damage.
Causes
Some main causes include:
Pelvic surgery: especially gynecological surgery, hysterectomy, bladder or urethral surgery.
Trauma or injury due to accident, surgical error, or direct invasion of bladder/urethral tissue.
Radiation therapy to the pelvic area is due to cancer, which can cause tissue necrosis, leading to fistula formation.
Chronic inflammation, prolonged infection: Crohn’s disease typically has fistulas that transition to the urinary tract.
Childbirth: prolonged labor, obstructed birth canal, tissue damage during childbirth can lead to vesicovaginal fistula.
Symptoms
Symptoms vary depending on the location and extent of the fistula:
Continuous urinary leakage: urine leaks out through an abnormal pathway (vagina, skin, intestines, etc.) when control cannot be maintained.
Painful urination, burning urination, urinary tract irritation: if there is inflammation or infection.
Unpleasant odor, continuous dampness in the external area due to contact with urine.
Recurrent urinary tract infections.
Skin lesion, skin ulceration if exposed to urine for a long time.
Gastrointestinal signs if the fistula extends to the intestines: there may be gas in the urine (pneumaturia), feces in the urine (fecal Uria).
If the fistula is large and long-standing, there may be impaired kidney function due to inflammation or stasis.
Diagnosis
The diagnostic process typically includes:
1. Detailed history taking and clinical examination
Previous surgeries, radiation, trauma, difficult childbirth.
Time of symptom onset, nature of the fistula (continuous or intermittent), amount of urine leakage, impact on quality of life.
Condition of the skin and tissue in the suspected fistula area.
2. Paraclinical methods/imaging
Dye test: Introducing dye (or contrast agent) into the bladder or intestine, then observing for leakage into the vaginal area, skin, or other organs. Johns Hopkins describes this test in the diagnosis of vesicovaginal fistula.
Cystoscopy/urethroscopy: Cystoscopy/urethroscopy to identify the fistula opening and the extent of lesion.
Imaging: Ultrasound, CT scan, or MRI to identify the fistula tract, evaluate surrounding tissue, its extent, and assess the impact on adjacent organs.
If an intestinal fistula is suspected: Bowel tests may be needed (colonoscopy) or imaging studies of the digestive tract.
Treatments
The treatments depend on the cause, location, size, length of the fistula, and the condition of the surrounding tissue.
1. Conservative treatment (non-surgical/ medical / supportive)
Continuous drainage: Placement of a bladder catheter or appropriate drainage to reduce pressure and allow small fistula to heal when continuously relieved of irritation.
Treatment of infection if present: Antibiotics, hygiene of the fistula area to reduce inflammation.
Skin care, protection of external tissues if urine contacts the skin.
2. Surgical intervention
Surgical closure of the fistula using an appropriate approach: transvaginal, transvesical, open surgery, or laparoscopy depending on the location.
Sometimes, a tissue flap from healthy tissue is used to reinforce the closure.
If there is lesion due to radiation or fibrotic tissue, extensive surgery or multi-layered tissue reconstruction may be necessary.
After surgery, a catheter is placed for a period to prevent sudden tension on the anastomosis, aiding tissue healing.
3. Monitoring and Recovery
Monitor for infection, kidney function, and assess the closure of the fistula.
Nutritional support measures if tissues have severe damage.
Reference:
--------------------
Để lại bình luận