Urinary Tract Fistula Treatment in Singapore

The most common type, occurring between the bladder and vagina. This results in continuous urine leakage through the vagina and accounts for approximately 80% of urogenital fistulas.

Forms between the ureter and vagina, typically following pelvic surgery or radiation therapy. Patients experience constant urinary leakage despite normal voiding.

A connection between the bladder and uterus, often resulting from caesarean sections or uterine surgery. May cause cyclic haematuria (blood in urine during menstruation).

Develops between the urethra and vagina, causing urine leakage during urination. Often results from prolonged labour or surgical trauma.

Forms between the colon and bladder, more common in men. Causes recurrent urinary tract infections and may result in passing gas or faecal matter through the urethra.

Connects the rectum and urethra, typically occurring after prostate surgery or radiation. Results in urine passing through the rectum or faecal contamination of urine.

Surgical Complications
• Hysterectomy (most common cause in developed countries)
• Caesarean sections
• Pelvic surgery for cancer
• Prostate surgery
• Colorectal surgery

Radiation Therapy
• Pelvic radiation for cervical, prostate, or rectal cancer
• Delayed fistula formation months to years after treatment

Inflammatory Conditions
• Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
• Diverticulitis
• Pelvic inflammatory disease

Trauma
• Obstetric trauma during difficult deliveries
• Pelvic fractures
• Foreign body injuries

Malignancy
• Pelvic cancers
• Tumour invasion into urinary structures

Medical History
• Previous pelvic surgery or radiation
• History of inflammatory bowel disease
• Prior difficult childbirth or obstetric complications
• Pelvic malignancies

Surgical Factors
• Emergency surgeries with inadequate preparation
• Surgeries involving adhesions
• Repeat pelvic operations
• Technical difficulties during surgery

Patient Factors
• Poor tissue healing (diabetes, malnutrition)
• Smoking
• Chronic steroid use
• Compromised immune system

• Small amounts of urinary leakage
• Mild skin irritation around affected area
• Occasional foul-smelling discharge
• Minor discomfort during urination

• Continuous urinary leakage requiring pad use
• Recurrent urinary tract infections
• Significant skin breakdown and irritation
• Social embarrassment and lifestyle limitations
• Vaginal discharge mixed with urine
• Difficulty maintaining personal hygiene

• Complete loss of urinary control
• Severe skin excoriation and infection
• Passing gas through urethra (colovesical fistula)
• Faecal matter in urine
• Severe pelvic pain
• Depression and social isolation
• Kidney infection or damage

The timing of symptom onset varies depending on the cause. Surgical fistulas typically manifest within 1-2 weeks post-operation, while radiation-induced fistulas may develop months or years later. Early recognition and treatment prevent progression to more severe complications.

A detailed pelvic examination helps identify the fistula location and assess surrounding tissue health. The urologist may use a speculum to visualise vaginal fistulas directly. This initial assessment guides further diagnostic testing.

A simple office procedure where coloured dye is instilled into the bladder through a catheter. The appearance of dye at the fistula site confirms the diagnosis and location. This test takes approximately 15-30 minutes with immediate results.

A thin camera (cystoscope) examines the bladder interior to identify fistula openings. This procedure can differentiate between bladder and ureteral fistulas. Local anaesthesia ensures patient comfort during the 10-15 minute examination.

CT urography or MRI provides detailed images of the urinary tract and surrounding structures. These scans reveal fistula anatomy, helping plan surgical repair. Contrast material enhances visualisation. Results are typically available within 24-48 hours.

Specialised tests assess bladder function and capacity, important for surgical planning. These studies evaluate whether the bladder can store urine normally after repair. Testing takes 30-45 minutes in an outpatient setting.

For very small fistulas diagnosed early, conservative treatment may allow spontaneous healing. This involves continuous bladder drainage via catheter for 4-6 weeks, allowing tissues to heal. Anti-inflammatory medications reduce local inflammation. Antibiotics prevent infection during the healing period. Success rates vary from 10-15% for small, uncomplicated fistulas. Regular monitoring ensures healing progress.

The primary treatment for vesicovaginal and urethrovaginal fistulas accessible through the vagina. This minimally invasive approach involves excising the fistula tract and closing the defect in layers. Tissue flaps may reinforce the repair. Recovery typically requires 2-3 days hospitalisation with catheter drainage for 2-3 weeks. Success rates exceed 85-90% for first-time repairs.

Complex or high fistulas require abdominal surgery for optimal access and repair. The surgeon separates the involved organs, excises unhealthy tissue, and performs multi-layer closure. Tissue interposition using omentum or peritoneum reinforces the repair. This approach suits radiation-induced fistulas or failed previous repairs. Hospital stay extends 3-5 days with 4-6 weeks recovery.

Modern minimally invasive techniques offer visualisation and precise tissue handling. Small incisions reduce post-operative pain and speed recovery. Robotic assistance provides enhanced dexterity for complex repairs. These approaches suit selected patients with favourable anatomy. Hospital discharge typically occurs within 1-2 days.

Severe cases with tissue damage may require permanent urinary diversion. Options include ileal conduit (urine drains into external bag) or continent diversion (internal pouch). This major surgery is reserved for irreparable fistulas or multiple failed repairs. Comprehensive counselling ensures patients understand lifestyle implications.

Tissue sealants and fibrin glue may supplement surgical repair in selected cases. Hyperbaric oxygen therapy improves tissue healing in radiation-damaged areas. Hormone replacement therapy optimises vaginal tissue health before repair. These complementary approaches enhance overall treatment success.