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Urinary Tract Fistula, Emergency Medicine

Denise S. Lawe Reviewed 06/2017
 


Basics

Description

Urinary tract fistulas can form between any part of the urinary tract and structures in the thoracic cavity, the abdominal cavity, the pelvis, and the skin. 

Etiology

  • Colovesical fistu...

Diagnosis

Signs and Symptoms

  • Colovesical fistula:

    • Chronic or recurrent UTIs

    • Suprapubic pain

    • Abnormal urine: Pneumaturia, fecaluria, hematuria, malodorous urine, debris in the urine (food particles)

  • Vesicov...

Treatment

Initial Stabilization/Therapy

Treat urosepsis (rare) with IV fluid bolus, pressors, and IV antibiotics as appropriate. 

Ed Treatment/Procedures

  • Colovesical fistula:

    • Evaluate for complications fr...

Follow-Up

Disposition

Admission Criteria

  • Sepsis

  • Inability to take oral antibiotics if needed

  • Acute emergencies from primary GI disease or malignancies

Discharge Criteria

  • No evidence of sepsis

  • Able to tolerat...

Pearls and Pitfalls

  • Suspect a urinary tract fistula in the patient with the appropriate risk factors (usually a complicated recent pelvic surgery) and recurrent UTIs

  • In the presence of urinary tract fi...

Additional Reading

  • Basler  J. (2012, Jan 23). Enterovesical fistula. Retrieved from www.emedicine.com.

  • Garely  AD, Mann  WJ Jr. (2012, Jul 30). Vesicovaginal, urethrovaginal, and ureterovaginal fistula...

Codes

ICD9

  • 596.1 Intestinovesical fistula

  • 599.1 Urethral fistula

  • 619.0 Urinary-genital tract fistula, female

  • 596.2 Vesical fistula, not elsewhere classified

ICD10

  • N32.1 Vesicointestinal fistula

  • N36.0 Urethra...

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