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Fistulas of the Genitourinary Tract: A Radiologic Review¹

¹ From the Department of Radiological Sciences, David Geffen School of Medicine, University of California, 10833 LeConte Ave, Los Angeles, CA 90095-1721. Presented as an education exhibit at the 1999 RSNA scientific assembly. Received November 26, 2003; revision requested January 16, 2004, and received February 24; accepted March 9. All authors have no financial relationships to disclose. Address correspondence to S.S.R. (e-mail: sraman@mednet.ucla.edu).

Fistulas of the genitourinary tract have diverse anatomic locations, causes, and clinical features. They can involve the upper urinary tract (kidney, ureter), the lower urinary tract (bladder, urethra), or the female reproductive tract (vagina, uterus). Causes include infection, inflammatory disease, neoplasms, congenital conditions, trauma, and iatrogenic injury. Diagnosis of genitourinary tract fistulas usually requires radiologic studies performed with fluoroscopic or cross-sectional modalities. Fistulography is the most direct means of visualizing a fistula and should be considered when feasible (eg, cutaneous fistulas). Intravenous urography and pyelography or ureterography are mainstays of investigation of the upper tract. Likewise, voiding cystourethrography and urethrography are central to study of the lower tract. Cross-sectional techniques, in particular computed tomography, are increasingly useful for diagnosis and are considered the primary test in some cases. Radiologists should be familiar with the radiologic features of genitourinary tract fistulas for accurate diagnosis and treatment planning. Management approaches depend on the type of fistula, the degree of morbidity, and the overall functional status of the patient and vary from conservative observation to aggressive surgical repair.

© RSNA, 2004

Index Terms: Fistula, genitourinary system, 80.245 • Genitourinary system, abnormalities, 80.245 • Genitourinary system, diseases, 80.245 • Genitourinary system, injuries, 80.245 • Urine, extravasation, 80.245

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