Genitourinary Tract Fistulas

  Gastrointestinal tract images
 Renocolic Fistula, Renocolic fistulas are usually secondary to renal inflammation or neoplasms. An occasional patient with xanthogranulomatous pyelonephritis
and ureteric obstruction develops a renocolic fistula. An antegrade or retrograde pyelogram should identify these fistulas. Computed mography usually reveals a complex air-fluid collection within either the kidney or the adjacent soft tissues.
Urethrorectal Fistula, Rare urethrorectal fistulas consist of fistulas communicating between the prostate or bulbomembranous urethra and rectum. Trauma from missiles is a not uncommon cause of these fistulas. A number of these patients have had prior surgery or complex anoperineal suppuration. Detection of urethrorectal fistulas is straightforward, either via a urethrogram or a contrast enema. Some of these fistulas close spontaneously after a more proximal-sigmoid colostomy and suprapubic cystostomy; others require surgical correction.
Colorectal Vesical Fistula, Most enterovesical fistulas are secondary to inflammatory bowel disease or diverticulitis, with an occasional one originating from a colon carcinoma, bladder carcinoma, or other neoplasms. Pneumaturia is common but not universal in patients with a colovesical fistula.At times cystitis is the primary presentation. Most colovesical fistulas can be identified by barium enema, cystography, or cystoscopy. In some patients a one-way check valve mechanism presumably exists, and in any one patient not all three studies identify a fistula.
Rectovaginal Fistula, Most rectovaginal fistulas are secondary to birth trauma, gynecologic surgery, or pelvic radiation. A rare cause is pelvic amebiasis or actinomycosis. Diverticulitis predominates as a cause of colovaginal fistulas. Either a barium enema or vaginogram identifies these fistulas. Pelvic MRI is useful to define involved tissue planes. T2- weighted images identify rectovaginal fistulas as hyperintense linear defects. Most internal opening can be identified. A nitinol-silicone double-disc device was inserted transrectally into a rectovaginal fistula and the fistula occluded. Such an occluding device appears useful in a setting of tumor, pelvic radiation, and reluctance for repeat surgery in someone with limited life expectancy.
image
This is radiology images of Rectovaginal fistula (arrow) secondary to lymphomatous infiltration.
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