The prevention and management of gynecological fistula always remains a big challenge. In gynecological fistulas, most common are vesicovaginal fistula, then ureterovaginal fistula followed by vesicouterine fistula. The rate was highest among women who had hysterectomy following cervical cancer. Isolated ureterovaginal fistula is rare. Patients with ureterovaginal fistula usually presents with continuous urinary incontinence with normal voiding in between, constitutional symptoms of fever, chills, malaise if infection or pelvic collection and some times flank pain secondary to hydronephrosis. Patient can present lately with poorly functioning of kidney. So early diversion or corrective surgery is warranted in this condition. Most common site involved is lower ureter.The aim of this study is to describe our experience of management of iatrogenic ureterovaginal fistula resultant of gynecological surgery and obstructed labour over a span of 10 years and outcomes.

We reviewed our database from 2009 -2019 and followed up this cohort of patient prospectively for outcomes.

A total of 15 patients with ureterovaginal fistula were identified. None of this cohort of patients had concurrent vesicovaginal fistula. Mean age of patient was 39 years. All patients presented with continuous urine leak with normal voiding in between. Five patients had laparoscopic hysterectomy, 7 underwent open transabdominal hysterectomy (cesarean hysterectomy for hemorrhage), 3 underwent transvaginal hysterectomy. Mean time to develop symptoms was 5 days after surgery. Mean time to discharge after primary surgery leading to iatrogenic fistula was 17 days. Time from fistula to corrective surgery was 9 months (1 month-3 years). 14 patients had percutaneous nephrostomy placed prior to surgery as a diversion measure. Kidney function was preserved in all patients. Before definitive surgery, check cystoscopy to rule out vesicovaginal fistula and nephrostogram was done in all patients. 13 patients underwent open extraperitoneal ureteroneocystostomy. 2 out of 13 patients needed Boari reconstruction as an adjunctive to ureteroneocystostomy. 1 patient underwent robot assisted and 1 underwent laparoscopic ureteroneocystostomy (transperitoneal). All the procedures used modified Lich-Gregoir technique for ureteric reimplantation. 1 patient was treated with just DJ stenting. Urethral catheters were removed at a mean of 10 days and DJ stents were removed at a mean of 5 weeks. Mean follow up of patient is 5 years (1-10 years). None of the patient had recurrent symptoms and all the patients are completely dry at present

Ureterovaginal fistulae is usually manged by reconstructive surgery. Some times, DJ stent can be tried in case of early diagnosis.

Ureterovaginal fistula are complicated by virtue of their cause and can be well managed by minimally invasive or open surgery. At times Psoas hitch or Boari reconstruction is warranted.