What you need to know about bladder hyperplasia? Bladder fistula: why it occurs and how to treat it

A fistula is a new formation in the human body, also called a fistula. It connects hollow organs to each other or gives them access to the outside. A fistula can also connect a tumor to the surface of the body or some organ of it Bladder. Treatment with folk remedies has repeatedly proven its effectiveness. Bladder fistula, diagnosis and treatment of the disease different methods and, first of all, treatment of bladder fistula with folk remedies - the topic of this article.

Bladder fistula: diagnosis and symptoms of the disease

Bladder fistulas come in several types. Some are the result of pathology (developmental disorders of the body), while others appear after surgical intervention in the body. By their nature, bladder fistulas can be purulent, gastric, rectal, bronchial and others. This pathology is curable, but often turning to doctors does not give the patient the desired effect. In such cases it helps a lot folk remedies fistula treatment.

Most often, the fistula is located at the base of the bladder and is large enough that some or even all of the urine may leak out of the vagina. If the fistula is small, then periodic leaks are observed.

The discharge must be collected and tested; if the amount of creatine and blood urea nitrogen exceeds 20 times their amount in the blood, then the presence of a fistula is proven.

Very often, gynecologists define urine discharge from the vagina as gray vaginal vault, which leads to delayed correct diagnosis.

Most often, after surgery, patients develop a ureterovaginal fistula. There are also urethro-vaginal and vesico-uterine fistulas.

Also often small discharge urine from the vagina is mistaken for stress incontinence.

Bladder fistula: causes of the disease

This is a disease that is sometimes found in women, with it between bladder and there is an opening in the vagina, because of which the patient experiences urinary incontinence.

Bladder fistula appears most often during childbirth and is caused by low level medicine and the level of training of obstetricians and gynecologists. At long labor Pressure on the bladder increases, bladder necrosis appears, and a fistula develops. The developed countries reduced the likelihood of pathology during childbirth to a minimum.

In 70-80% of cases, the fistula appears after surgery, the causes being abdominal hysterectomy and vaginal hysterectomy. Bladder fistula develops after radiation therapy, most often it manifests itself six months to a year after the end of treatment, but in some cases even after several years.

A week or two after surgery, patients begin to experience watery vaginal discharge that is not accompanied by painful sensations. The volume of discharge depends on the size and location of the fistula.

Bladder fistula: traditional treatment

The fistula closes surgically. If its size is small, then it is enough to use the method of electrocoagulation, which is carried out on the epithelialized part, or a Foley balloon catheter is installed in the bladder, where it remains for several weeks. The operation can have either vaginal or suprapubic access.

Bladder fistula: treatment with folk remedies

Bladder fistula can be cured with simple St. John's wort. Three tablespoons of St. John's wort are boiled for several minutes in a glass of water, after which the hot herbal paste is spread on cellophane and a hot compress is applied to the area affected by the fistula. Until all the pus comes out of the fistula, the procedure should be regular. After cleansing, you should apply the same compresses several more times.

Bladder fistula can also be treated with other folk remedies. So, for example, you can take 10-12 aloe leaves (the plant should not be quite young), infuse the crushed leaves into a pulp in a liter of honey and take it orally three times a day. Dose – one teaspoon. The product should sit in a dark place for at least one week. The fistula can also be washed with furatsilin solution.

A bladder fistula can also resolve with other folk remedies. So, you can make an ointment. For its basis you should take lard. Active components such plants as: water pepper grass (pepper knotweed), toadflax flowers and oak bark appear. All components must be crushed and dry. They are easy to buy at the pharmacy. The ratio of fat and grass is: 2:1. All ingredients, mixed in a fireproof container, are placed in the oven over low heat and simmered for at least 8-10 hours. Ready ointment for cotton swabs applied to the fistula. The cotton wool should be changed every half day.

Fistula disease requires persistent and careful treatment with folk remedies. Therefore, do not despair if one of the remedies does not help. It is necessary to change it or try to treat it in combination with other folk remedies. So, you can additionally treat a bladder fistula with herbal tinctures in alcohol (calendula, hawthorn, peppercorn). This will reduce inflammation of the fistula and dry it out if your disease is purulent.

The urinary bladder (UB) is a natural reservoir for storing urine. Normally it is released through urethra(urethra) in external environment. Let's consider states when the path provided by nature does not work.

Bladder fistula

A fistula is an unnatural way of communication between the bladder and the skin, surrounding tissues and organs. In women - intestines, uterus, vagina. In men - intestines, prostate.

Inside, this canal is lined with epithelium or granulation tissue, narrow, and measures from a point to 10 mm. Most often, the fistula is associated with the intestine or vagina. It comes out onto the skin through one or more openings from which urine is released.

The skin at the sites of discharge is red, inflamed, and sometimes the discharge is purulent. A fistula (fistula) can have more than one course, a complex, tortuous structure, and pockets. Suppuration in the pockets often occurs, forming phlegmons or abscesses. If the fistula extends into the internal organs, the contents of the bladder are poured into them, leading to disruption of the structure and inflammation of the latter.

There are combined fistulas, in these cases there is more than one communication route: urethra-bladder-vagina, or bladder-vagina - intestines, etc. More often, women are exposed to this disease due to birth trauma.

Kinds

There are several classifications of this disease. They are distinguished according to their causes and anatomical features:

Congenital and acquired fistulas are classified.
External and internal.
Lip-shaped, epithelializing, granulating (according to cellular composition).

Congenital fistulas occur when the formation of urinary system during pregnancy. These include vesico-intestinal and vesico-umbilical communications (vesico-umbilical fistulas: incomplete and complete).

Acquired – arising throughout life as a result of injuries, burns, gunshot wounds, past diseases, medical errors. The severity of the process depends on the degree of damage, psychological state sick, long ago.

The following types are distinguished in women:

Vesical-vaginal (between the bladder and vagina - 60%).
Vesicouterine (between the uterus and bladder).
Vesico-adnexal (MP and uterine appendages).
Enterovesical (MP and intestines).
Vesico-urethro-vaginal (MP-urethra-vagina).
Vesicoureterovaginal (VU-ureter-vagina).
Vesicovaginal-rectal (VV-vagina-rectum).

Types of bladder fistulas in women

For men:

Vesicointestinal.
Urethroprostateperineal.
Urethroprostate-rectal.

Artificial fistulas are created by urologists in men and women as a need to remove urine when the bladder is blocked. This required method treatment.

Causes

Congenital fistulas are formed due to complete or incomplete non-fusion of the urachus (normally it should be completely closed). This process occurs in the fifth month of pregnancy, when the size of the fetus is 250 mm and weight is 0.340 kg. Transferred viral diseases, alcohol consumption, smoking, teratogenic drugs, occupational hazards can alter embryogenesis.

Among women

Acquired - appear most often due to injuries during gynecological operations, characterized by increased complexity or the urgent state of the patient. During childbirth - during the provision of obstetric services, operations in extreme conditions: uterine bleeding, acute fetal hypoxia.

The second common cause is purulent-inflammatory processes in the uterine appendages: salpingo-oophoritis, pyosalpinx, pelvioperitonitis. During purulent inflammation tissue “melting” occurs.

Later they are replaced connective tissue– scars form, or “solder” to other organs (a fistula is formed at the fusion site). Foci of endometriosis in the pelvis can also behave.

Presence of decaying or germinating malignant tumors in the bladder or neighboring organs, the consequences of radiation therapy (disrupted tissue nutrition) are the third cause of the disease in women.

The use of vaginal and cervical rings for prolapse of the uterus and vagina (as a result of long-term wearing bedsores and inflammations form) – possible reason diseases.

In men

Injuries during urological operations. Prostate tumor growth into the prostate wall. Bladder injury. Damage to the rectum during prostate removal, paraproctitis. The causes may be tuberculosis and actinomycosis of the pelvic organs. Inflammation of the prostate gland.

Common causes for both men and women are intestinal diseases: Crohn's disease, diverticulitis ( inflamed bowel melts the wall of the bladder and connects to it through the fistula).

Symptoms

With vesicovaginal fistulas caused by trauma, spontaneous leakage of urine from the vagina occurs on the first day or after 7-10 days. It matters whether the patient can urinate on her own. If not, the diameter of the fistula is significant.

May be bothersome from periodic aching pain above the pubis, in the vagina and lower abdomen. Take place psychoemotional disorders. When an infection occurs, the body temperature rises, the pain becomes more intense, radiating to the lower back and thigh. Vaginal discharge contains an admixture of pus and is foul-smelling.

Vesico-adnexal fistulas are more severe - intoxication is pronounced, intense pain in the small pelvis. In cases of urine entering the uterus, there may be menouria (menstrual blood in the urine), and absence of menstruation.

If the bladder connects to the intestines, urine pours into the intestinal lumen, disrupting the functioning of the intestines: proctitis and sphincteritis develop. In turn, the contents of the intestines enter the bladder, causing constant inflammation of the genitourinary system.

With external fistulas, patients complain of skin irritation, constant wetting around the fistula, and an unpleasant odor of urine. Vesico-rectal causes overflow of urine into the rectum with leakage of contents, inflammation of the mucous membrane and skin around the anus.

Diagnostics

Schemes for examining patients differ from the types of fistulas, their sizes, and connecting organs, but all diagnostic methods include interviewing and examining the patient. Such patients are treated by a gynecologist and urologist. They determine the scope of necessary examinations.

Laboratory diagnostics:

A general blood test determines the presence of an infectious process in the body.
Biochemical blood test - control functional state kidney
General urinalysis - determination of infection of the kidneys, bladder, urethra.
Analysis vaginal discharge– will help determine the presence of infection and traces of urine.

Instrumental diagnostics:

Vaginoscopy - the integrity of the vaginal wall is compromised, an admixture of uric acids in the analysis of discharge.
Excretory urography - allows you to identify anatomical disorders urinary tract using a contrast agent injected into the body and an x-ray machine.
Fistulography - contrast is injected into fistulous tract, do X-ray, it shows the entire structure and branches of the fistula.
– examination of the walls of the bladder with an optical object. Allows you to see anatomical disorders.
Administration of indigo carmine through a catheter into the bladder against the background of vaginal tamponade. If there is a message between them, the tampons will be colored with dye.
Rectoscopy is an examination of the inner surface of the rectum using mirrors. Allows you to identify the opening of the fistula and confirm the communication with the bladder by introducing an indigo carmine solution (dye) into the urethra; it will enter the rectum unchanged.
Ultrasound scanning using a vaginal sensor with a filled bladder allows you to see a defect in the genitourinary septum.
A biopsy of the tissue around the fistula opening is done if a malignancy is suspected.
Hysteroscopy is an examination of the uterine cavity using an eyepiece. Allows you to determine the communication between the uterus and the bladder.

Whatever methods are proposed to clarify the diagnosis, they are evaluated in conjunction with laboratory research general analysis blood, urine, biochemical parameters, psychostatus of the patient. An adequate approach is half the success in choosing treatment.

Treatment

Drug therapy

The use of this type of therapy gives a 2 percent recovery rate. Conditions for its implementation: absence of infection, granulating vesicovaginal fistula, not exceeding 0.3 cm in diameter.

Use continuous catheterization of the bladder for three to six weeks, wash it with antiseptics, and sanitize the vagina antibacterial drugs, tamponed with soaked sterile Vaseline oil tampons.

In parallel, uroseptics (Furagin, 5-NOK, Palin, Nitroxoline) and antibiotics (Tsiprolet, Norfloxacin, Ceftriakone) are prescribed. Recipe for success conservative therapy– cessation of circulation of excreted urine through fistulas.

Surgical intervention

The principles of its implementation are individual approach to every patient.

Conditions for the operation:

absence of inflammation in the fistula area;
sufficient blood supply to surrounding tissues;
absence of infectious process in the urinary tract;
normal mental state and general health patient;
the duration of the disease is from two to three months from the moment of formation.

Conditions for a successful postoperative prognosis:

small fistula size;
order of operation (primary);
good operational access to the fistula;
high professionalism of the surgeon;
postoperative drainage of the bladder for two weeks;
the reason for the formation of a fistula (benign).

If we're talking about about vesicovaginal fistulas - surgical vaginal access. During the operation, the fistula tract is excised and the fistula is closed, the scars are dissected, the vaginal and bladder walls are stratified, and the normal anatomy of the organs is restored.

To eliminate vesico-adnexal fistulas, abdominal access (through the abdomen) is used. This route is used for the treatment of vesicular fistulas located high in relation to the ureter, with existing urinary leaks. Scar changes vagina due to radiation therapy - an indication for abdominal access.

Technical difficulties arise when closing post-radiation, combined, vesicocervical, urethroprostate-rectal fistulas. In men, they use perineal, rectal and abdominal surgical approach. Operations can be two-stage.

In case of vesicointestinal fistula, a colostomy is created on the bladder (an artificial intestinal fistula connecting it to the skin) .

It may be necessary to remove part of the intestine, remove the bladder, and drain urine directly from the ureters into the intestines. Before intervention, careful preoperative preparation patient.

Sluggish infectious process may lead to complications and repeated surgical interventions. Before the operation, the MP is washed with antiseptic solutions, cleansing enemas, and colimycin is prescribed. After surgery it is necessary long-term use antibiotics, sexual abstinence for up to three months.

Alternative therapy

Transplantation of allogeneic fibroblasts along the fistula. Stages of therapy:

fistula sanitation;
fibroblast transplantation;
protecting the wound with waxed gauze;
exposure to long-frequency laser radiation 24 hours after surgery for 10 days. 5 minutes every 12 hours before dressings;
in parallel, take Trianol 2 capsules per day for a month;
At this time, the bladder is catheterized for a week.

In some situations, under medical supervision, the patient decides to use traditional methods treatment.

Folk remedies

Treatment with folk remedies is used in the treatment of many diseases.

There are recipes to help cope with small and uncomplicated fistulas:

50 ml each olive oil and vodka mix in a ceramic or glass bowl. Wipe the fistula opening on the skin 3 times a day for 14 days. Apply to this place at night cabbage leaf, the side growing from the stalk. Used to treat small external fistulas.
50 grams of St. John's wort is poured into 300 ml of boiling water, boiled for 5 minutes, filtered while hot. Place the remaining porridge on compress paper and sit on the compress for 15 minutes. The remaining broth is washed after the procedure. Treatment for small vesicovaginal fistulas helps. Cannot be used by cancer patients.

Prevention

There are methods to prevent this disease. These include timely detection and treatment of inflammatory processes in organs genitourinary area and intestines. Childbirth and gynecological operations in specialized medical institutions. Compliance with the schedule of medical examinations for the timely detection of diseases leading to this pathology.

One of the violations of the normal flow of urine is a fistula of the bladder - this is a connection created by a pathological process between the bladder and other organs or with the skin. The occurrence of such a move can occur with intestinal loop or genitals. The problem is that the activity of the digestive and genitourinary systems is disrupted, and tissue irritation occurs with urine, and a secondary infection occurs.

What types of fistulas are there?

External - connection of the bladder with the skin. In this case, a specific hole is formed in the thickness of the skin. More often, the course is tortuous, which is dangerous due to the development of depressions into which urine gets in and provokes an inflammatory process.
Internal - creating a communication between a bladder and hollow organs.

There is also a piece fistula of the bladder, which is specially created by surgeons when surgical interventions. Piece connection is made at heavy operations for the purpose of removing urine when the body is not able to remove urine naturally. This type of urinary fistula is classified as external, since it is optimal and safe way excretion of urine.

The reasons for such moves

Incorrectly performed abortions.
Operations in gynecology.
Difficult birth.
Bladder tumors.
Frequent infectious diseases.
Injuries.
Radiation exposure.
The use of synthetic materials for the treatment of urinary incontinence.

Crohn's disease and intestinal tumors can cause a pathological connection of organs.

Symptoms of a fistula in the bladder

With this pathology, a person experiences pain during urination.

Involuntary leakage of urine and watery discharge from the vagina.
Frequent infectious diseases of the genitourinary system.
Pain when urinating.

The pathological passage between the bladder and the intestines has special symptoms. Urine enters the intestines, which is manifested by a violation of the consistency of excreted feces and severe flatulence. In addition, urine irritates the intestinal wall, which can lead to inflammation and ulceration. External bladder fistula is manifested by redness, burning and purulent complications on the skin where the pathological passage opens. Skin changes appear in the area below the navel, corresponding to the projection of the affected organ. Except purulent discharge, a specific smell of urine may appear. Development inflammatory process skin leads to disruption general condition, increased body temperature.

Diagnostics to make an accurate diagnosis

First of all, a blood test may indicate a bladder fistula, since creatinine and urea levels will be 20 times higher normal indicators. Using mirrors, a urologist or gynecologist identifies a fistula. TO additional methods diagnostics include x-rays using special contrast agents. This method allows not only to make a diagnosis, but also to determine the size of the pathological course and the affected organ. TO modern methods diagnostics include such a specific method as fistulography. Applicable A complex approach to the diagnosis of this disease, since the symptoms are nonspecific and are similar to other diseases of the genitourinary system.

Treatment of the disease: conservative and surgical methods

For small vesico-vaginal fistula, antibiotic therapy is indicated.

Conservative treatment is only possible for vesico-vaginal fistulas, not large sizes. The woman is given a catheter to eliminate urine and to wash the affected organ. The vagina is treated antiseptics using sterile swabs. In parallel, the patient undergoes a course of antibiotics and uroseptics to eliminate the infection. Scarring of the fistula occurs after 2 months of treatment. If conservative methods were not successful, you need to apply surgical intervention.

Operations to remove fistulas are carried out as planned, since the first step is to eliminate inflammatory processes in the genitourinary system. In women, the site of access to the bladder may be through the vagina or above the pubis. In men, surgery is performed through the perineum. The operation is called fistuloplasty. Regardless of the access, the pathological course and scarred parts of the wall of the affected organs are removed, the edges are sutured, restoring the normal anatomy of the organs. After the operation, an epicystostomy is placed, less often - a permanent catheter.

In practice, there is data on the treatment of fistula with folk remedies. These include the use of celandine and laurel. The effectiveness of this treatment has not been proven.

A fistula in the bladder (fistulaevesicaeurinariae) is an unnatural formation of a pathological passage between the bladder and adjacent internal organs (vagina, intestines) or skin of the body, which leads to the release of urine through the organ involved in the process, persistent infections urinary tract. A fistula is formed as a result of suppuration, which eventually opens and opens a passage into the body. It is believed that fistulas cannot heal on their own because fluid is constantly leaking through them.

A fistula is a passageway for the outflow of purulent or mixed contents from a source of suppuration onto the surface of the skin or into another hollow organ connecting them to each other, or towards the nearest bone. In accordance with this, fistulas are divided into internal and external.

Types of bladder fistulas

External fistulas include fistulas formed in the cavities and tissues of internal organs, through the channels of which liquid masses of various quantities and contents are released. External urinary fistulas generally have a labiform, short straight course leading from the epithelium of the bladder walls to the surface of the skin, where there is hyperemic purulent lesion hole. Sometimes external fistulas have a more complex structure with long winding passages and pockets, which contributes to the formation of phlegmons and abscesses in the surrounding tissues. After restoration of patency of the urinary tract, such fistulas may spontaneously close/overgrow.

By internal we mean fistulas that connect the source of inflammation with a hollow adjacent organ without the discharged contents coming to the surface so that damage/inflammation of the latter occurs.

Fistulas in the bladder can be congenital or acquired.

Congenital fistulas of the bladder are a consequence pathological development embryo, when the ducts and cracks are not completely or partially closed. For example, if the urinary duct does not completely close, then a fistula forms between the navel and the bladder; the same unclosed hole between the bladder and the intestines also refers to fistulas. Congenital bladder fistulas include:

vesico-umbilical;
vesicointestinal.

Acquired fistulas in the bladder are much more common. The main reasons for their development are a combination of injuries, inflammatory and purulent processes due to complications of diseases of the urinary system and abdominal cavity, changes in tissue trophism after radiation therapy of tumors, decay of tumors of the pelvic organs, tuberculosis, osteomyelitis. If fistulas occur between the bladder and female organs different types:

vesicovaginal fistula;
vesicocervical;
vesicouterine;
vesico-adnexa;
parametric vesical fistula.

Rarely occurring complex (combined) types of urinary fistulas in women:

urethro-vesicovaginal;
ureterovesical-vaginal;
pouch-vaginal (between the orthotopic bladder, created artificially from the intestine, and the vagina);
enterovesical fistulas (urinary-intestinal fistulas due to damage to the intestinal wall).

Urogenital fistulas in women more often arise as a result of careless, missed or unprofessionally eliminated injuries urinary organs during obstetric and gynecological operations, criminal abortions or in connection with trophic disorders of the bladder wall during long, complicated childbirth, injuries of the ureter and bladder during gynecological operations. The fact of genitourinary fistula is a serious medical and social problem.

The openings connecting the bladder and intestines are called “vesico-intestinal fistulas”, and the pathological duct between the bladder and the pelvic organs is called “vesico-genital fistula”.

Urinary fistulas also differ according to etiology and localization:

ureterovaginal;
vesicovaginal (the most common of all possible fistulas of the genitourinary system);
urethro-vaginal;
vesico-rectal;
urethro-rectal;
perineal;
urethro-rectal;
urethro-prostatorectal;
vesico-vaginal;
urethro-vesical;
ovario-vesical;
salpingo-vesical;
urethro-vaginal.

A separate list includes artificial (artificial) external fistulas of the bladder, which are the result of necessary surgical procedure for urine excretion in diseases such as nephrostomy, cystostomy, prostate hypertrophy, urethral stricture and others.

In the presence of genitourinary fistulas, natural urination may persist, but there is a constant leakage of urine from the vagina.

Causes of bladder fistulas

Acquired bladder fistulas are usually of traumatic, inflammatory, oncological or radiation origin.

Common causes of enterovesical fistulas are intestinal cancer, Crohn's disease, and diverticulitis.

The most common are vesicogenital fistulas (up to 65%), uniting the organs of the genitourinary system, observed mainly in women as a result of injuries received during complicated childbirth, medical and criminal abortions, injuries to the ureter and bladder during gynecological operations, diagnostic curettage, hysterectomy. Prolonged labor, narrowness of the pelvis of a woman in labor, and an illiterate choice of surgical delivery methods can cause the formation of fistulas.

Other causes of fistula formation include injuries to the bladder and urological operations (for example, transurethral removal of bladder tumors).

Fistulas of inflammatory origin can form when a pyosalpinx, parametritis, prostate abscess, etc. breaks into the bladder. purulent formations small pelvis.

Often, bladder fistulas are formed as a result of tumor growth into the bladder wall due to bladder cancer, vaginal cancer, prostate cancer, etc. Bladder fistulas can develop after a course of radiation therapy of the pelvic organs (1-5% of cases) after several months or years after the end of therapy, due to impaired tissue trophism or tumor disintegration.

IN Lately Another reason for the development of genitourinary fistulas was discovered - the widespread use of synthetic materials for the treatment of urinary incontinence and pelvic organ prolapse.

Symptoms of bladder fistula

Bladder fistula, its symptoms are not very diverse, but there are differences:

Vesicovaginal (vesico-vaginal) fistulas reveal themselves 1-2 weeks after childbirth or abdominal surgery by the constant flow of varying amounts of urine from the vagina, which depends on the size of the fistula. Since natural urination is preserved, this flow of urine from the vagina is referred to as stress urinary incontinence. Usually such fistulas are very big size, and the entire contents of the bladder may leak from the vagina, and this may also disrupt menstrual cycle, cause colpitis and cystitis.

Parametric-adnexal, vesico-adnexal, combined fistulas, as a rule, lead to a clear general intoxication of the body, pain in the pelvic organs, the normal functioning of which is disrupted by the presence of the fistula. When a fistula ruptures into the intestines, it liquefies feces and causes gas formation (flatulence).

Ureterovaginal fistula most often occurs after radical operations at malignant lesions cervix and uterine body, during removal (extirpation) of the uterus due to large fibroids, incl. through the vagina. Another cause of ureteral injury is burns during laparoscopic procedures. Most often, one side is affected, but a bilateral process also occurs.

One of the main symptoms of ureterovaginal fistulas is the constant release of urine along with the natural act of urination. Often, before the unnatural flow of urine from the vagina, the disease manifests itself acute inflammation kidneys (obstructive pyelonephritis) due to impaired outflow of urinary fluid, and sometimes pain in the affected side with no signs urinary infection. In these circumstances, patients need urgent restoration of urination using percutaneous kidney puncture. After creating an artificial fistula in the ureter, the pain usually goes away and the body temperature drops to normal. In the greatest number of cases with this type of fistula, disturbances in the proper functioning of the kidneys are observed.

Vesicouterine fistulas are an extremely rare type of genitourinary fistula. The reason for their formation is usually a bladder injury during caesarean section in the lower sector of the uterus. The main symptoms that attract attention are: leakage of urine from the vagina, the presence of menstrual blood in the urine, which is called cyclic menouria (Yussif's symptom), as well as amenorrhea (absence of menstruation).

Diagnosis of bladder fistulas

As with any disease, early and reliable diagnosis extremely important. To identify a fistula, determine its location, type and size, and the complexity of the condition, the following studies are carried out:

examination of the vagina using speculum;
digital examination of the rectum, anoscopy and sigmoidoscopy;
biochemical study of vaginal transudate;
cystoscopy against the background of tight vaginal tamponade with gauze tampons;
tests with indigo carmine dye and a catheter (to detect small, point fistulas);
bacterial culture of urine and urethral discharge;
bacterial examination of a vaginal smear;
biochemical blood test;
vaginography, excretory urography, cystography, chromocystoscopy, retrograde ureteropyelography;
fistulography;
biopsy and histological examination edges of the fistula;
ultrasonic and X-ray examination bladder and pelvic organs.

Treatment of bladder fistulas

Bladder fistula, its treatment should be individual and comprehensive. Treatment of fresh and pinpoint (no more than 2.5 cm in diameter) vesicovaginal fistulas in the bladder is usually conservative:

Foley catheter in the bladder for 30 days;
bladder instillation;
ointment tampons in the vagina;
drug therapy with uroseptics and antibiotics;
surgical treatment (fistuloplasty) after 6-8 weeks if necessary.

For long-term non-healing bladder fistulas, the fistula is closed surgical method after effective anti-inflammatory drug therapy. It is important that for any type of bladder fistula, fistuloplasty is performed, when the walls of the bladder are separated from neighboring organs and tissues, tissues damaged by the pathological process are excised, the edges of the defect are refreshed, and it is sutured, while a special catheter is left in place for a short time.

A bladder fistula (urinary fistula) is removed using a suprapubic, transvaginal (in women), perineal (in men), or a combination approach.

In case of vesico-intestinal fistula, it may be necessary to create an artificial temporary fistula (colostomy), resection of a section of the intestine, transplantation of the ureters into the intestine, or removal of the bladder with the creation of an artificial reservoir for urine in the intestine.

Self-closure of genitourinary fistulas is extremely rare, but sometimes folk remedies help, which should be used under the supervision of professionals.

Prevention of bladder fistulas

Preventive measures for bladder fistulas in women should be as follows:

professional organization of childbirth assistance;
special attention to pregnant women narrow pelvis, large fruit, transverse position fetus, etc.;
increasing safety during abdominal and laparoscopic operations, protecting against damage to internal organs, especially during gynecological operations;
constant attention to timely recognition of injury to the urinary organs;
competent and reliable diagnosis of the occurrence of a fistula;
choice optimal methods eliminating the problem of bladder fistula.

Thus, by and large, everything depends on the accuracy of the doctors.

Bladder fistula occurs in women and men

Bladder fistula- this is a defective painful passage that combines the organs of the abdominal cavity and groin, or the skin with the bladder. The hole has the shape of a narrow channel lined with epithelium or granulation tissue, through which urine flows from the bladder to nearby organs, skin and through them out. A fistula is formed as a result pathological process in internal organs, damage them as a result of invasive intervention and provokes continuous infection genitourinary organs.

Types and classification of genitourinary fistulas

Bladder fistulas can be:

Depending on the location of fistulas in the genitourinary tract in women, it can be in the following areas of the body:

bladder, vagina, rectum;
the bladder, ureter, and vagina maintain communication through the fistula canal;
the bladder, urethra, and vagina have commonalities with each other and transmit urine;
the bladder and part of the uterus have one pathological canal;
between the bladder and vagina.

In men, there are other types of fistula:

vesicointestinal;
urethro-prostate-perineal;
urethro-prostate-rectal.

The name of the type of fistula is determined by the impact nearby organs and the formation of a channel hole between them.

Pathology can occur due to many reasons

The main causes of a fistula in the bladder

The origin of a fistula in the bladder is different in men and women, since the structure of the body and genitourinary organs is different.

But they are united by their root causes pathological formation:

Injury to organs. Operational events, accidents, shocks and other reasons that violate the integrity of tissues contribute to the formation of a hole in the bladder;
Inflammatory diseases. The pathological condition is accompanied by the release of pus from the body, which can rupture the intercellular partitions and provoke a pathological fistula channel;
Malignant formations. Oncological tumor has the property of changing the structure and volume of organs, tearing walls, transferring cancer cells to neighboring areas;
Radiation exposure. The appearance of a fistula is a complicated condition after irradiation.

The common factor in the appearance of a fistula in men and women is intestinal diseases, when the integrity of the wall of a hypertrophied and painful organ is disrupted and it communicates with the bladder.

Symptoms and treatment methods for fistula in men and women

The main symptom of a fistula in the bladder is the constantly present smell of urine at the site of the fistula or discharge with purulent contents and a portion of urine. The disease is diagnosed in men by a urologist, in women by a gynecologist. Appropriate examination of pathological organs is carried out and treatment is prescribed, taking into account the causes of the fistula. Most often, methods are used to close the pathological canal.

Signs of a fistula

Depending on the location of the fistula, leakage of urine through the affected organ is observed:

External fistulas have a short course and obvious signs, in contrast to the internal location of the fistula opening, when detecting the location of the fistula requires the use of several diagnostic measures due to the long tortuous channel of formation between the abdominal organs.

Laboratory and instrumental diagnostic methods

The primary diagnosis of bladder fistula consists of interviewing and examining the patient with a urologist and gynecologist. Doctors determine the need and list of laboratory and instrumental examinations of the body.

To clarify the diagnosis you need to:

Analysis of blood and urine samples. Detects infections and the condition of the renal system;
Inspection of the internal walls of the organ using an endoscope. Determines the integrity of bladder cells;
Examination of the internal walls of the rectum with an endoscope;
Ultrasound of the bladder. Allows you to identify organ defects;
Microscopic examination of canal tissue. Detects malignant tumors;
X-ray examination of the bladder. Contrast agent paints pathological areas in different colors.

Additional research procedures are provided for women:

Analysis of vaginal definitions. The infectious agent and the presence of urine are detected;
Tamponing examination of the vagina. Inserted into the bladder through a catheter coloring matter and if there is a vesical-vaginal fistula, then the tampon in the vagina is painted in a similar color;
Hysteroscopy. Examination of the uterus through an ocular instrument;
Vaginoscopy. Analysis of secretions shows the integrity of the walls of the organ and the presence of uric acids in the studied volume.

Cumulative assessment of laboratory and instrumental studies allows you to accurately determine the location of the fistula and take measures to eliminate the pathological formation.

IN extreme cases surgery required

Surgical and drug treatment

Drug treatment of fistulas includes taking antiseptic, anti-inflammatory, antibacterial drugs in addition to uroseptics. This is permissible if the diameter of the fistula is no more than 3 mm in diameter. Required condition when used conservative treatment is to establish permanent catheter for instillation of the bladder - infusion medicinal solution into the bladder.

There are cases when the fistula closes on its own, but this happens in 2-3% of cases. In the remaining range of patients, surgical intervention is necessary to stop the development of the inflammatory process and recovery healthy condition genitourinary system.

Surgical treatment of a fistula involves closing the fistula opening. Patients undergo surgery in various ways:

through an incision in the area above the pubis;
removal of fistula through the perineum;
invasive intervention through the vagina (women).

Acceptable use combined method removal of pathological formation. Sometimes during the operation an artificial reservoir is constructed for the outflow of urine from the bladder; subsequently, the available outflow of urine is removed and the tissue of the defective organ is sutured. After the operation, it is necessary to follow measures to care for the painful area, abstain from sexual intercourse for 3 months and drink a course of medicines prescribed by a doctor.