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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).

View larger version (134K): [in a new window]   Figure 1a.  Calicocutaneous fistula as a complication of partial nephrectomy for renal cell carcinoma. (a) CT urogram shows air in the collecting system (arrow) and contrast material extravasating to the incision site (arrowhead). (b) CT urogram obtained at another level shows the fistula (arrowheads) extending outside the kidney through the soft-tissue layers. (c) Nephrostogram also shows the leaking contrast material (arrowhead). Percutaneous nephrostomy was performed to divert the urine to aid healing of the fistula.

View larger version (137K): [in a new window]   Figure 1b.  Calicocutaneous fistula as a complication of partial nephrectomy for renal cell carcinoma. (a) CT urogram shows air in the collecting system (arrow) and contrast material extravasating to the incision site (arrowhead). (b) CT urogram obtained at another level shows the fistula (arrowheads) extending outside the kidney through the soft-tissue layers. (c) Nephrostogram also shows the leaking contrast material (arrowhead). Percutaneous nephrostomy was performed to divert the urine to aid healing of the fistula.

View larger version (106K): [in a new window]   Figure 1c.  Calicocutaneous fistula as a complication of partial nephrectomy for renal cell carcinoma. (a) CT urogram shows air in the collecting system (arrow) and contrast material extravasating to the incision site (arrowhead). (b) CT urogram obtained at another level shows the fistula (arrowheads) extending outside the kidney through the soft-tissue layers. (c) Nephrostogram also shows the leaking contrast material (arrowhead). Percutaneous nephrostomy was performed to divert the urine to aid healing of the fistula.

View larger version (145K): [in a new window]   Figure 2a.  Lymphaticocalicoforniceal fistulas in two patients with filariasis. (a) Lymphangiogram shows leakage of contrast material, which highlights the calices (arrow). (b) Lymphangiogram shows opacification of the calices and ureter (arrow).

View larger version (155K): [in a new window]   Figure 2b.  Lymphaticocalicoforniceal fistulas in two patients with filariasis. (a) Lymphangiogram shows leakage of contrast material, which highlights the calices (arrow). (b) Lymphangiogram shows opacification of the calices and ureter (arrow).

View larger version (136K): [in a new window]   Figure 3.  Ureteroileal fistula in a patient with retroperitoneal fibrosis and high ureteral obstruction. Intravenous urogram shows left-sided hydronephrosis and extravasation of contrast material into the retroperitoneum (R) and eventually into the ileum (I). The exact site of the fistula in the small intestine is not seen.

View larger version (159K): [in a new window]   Figure 4.  Ureteroarterial fistula. Retrograde ureterogram shows transient filling of an arterial vessel (arrow). Ureteroscopy showed pulsating hemorrhage, which confirmed the diagnosis.

View larger version (178K): [in a new window]   Figure 5a.  Ureterocutaneous fistula as a complication of ureterolithotomy. (a) Nephrostogram shows gross disruption of the proximal ureter (arrow) with extravasation of contrast material. (b) Nephrostogram of another patient shows a more subtle proximal ureterocutaneous fistula (arrows).

View larger version (148K): [in a new window]   Figure 5b.  Ureterocutaneous fistula as a complication of ureterolithotomy. (a) Nephrostogram shows gross disruption of the proximal ureter (arrow) with extravasation of contrast material. (b) Nephrostogram of another patient shows a more subtle proximal ureterocutaneous fistula (arrows).

View larger version (161K): [in a new window]   Figure 6.  Ureterovaginal fistula after total abdominal hysterectomy and bilateral oophorectomy in a woman with cervical cancer. Intravenous urogram shows an abnormal communication (arrow) and contrast material filling the vagina (arrowheads).

View larger version (109K): [in a new window]   Figure 7a.  Ureterovaginal fistula in a woman with a watery vaginal discharge. (a) VCUG image shows a normal appearance. Thus, a vesicovaginal or urethrovaginal fistula is ruled out. (b) Intravenous urogram shows obstruction of the left ureter, which is likely due to a surgical clip (arrow). (c) CT urogram shows the fistula, which is faintly outlined by contrast material (arrowheads). (d) CT urogram shows resultant opacification of the vagina (V).

View larger version (119K): [in a new window]   Figure 7b.  Ureterovaginal fistula in a woman with a watery vaginal discharge. (a) VCUG image shows a normal appearance. Thus, a vesicovaginal or urethrovaginal fistula is ruled out. (b) Intravenous urogram shows obstruction of the left ureter, which is likely due to a surgical clip (arrow). (c) CT urogram shows the fistula, which is faintly outlined by contrast material (arrowheads). (d) CT urogram shows resultant opacification of the vagina (V).

View larger version (157K): [in a new window]   Figure 7c.  Ureterovaginal fistula in a woman with a watery vaginal discharge. (a) VCUG image shows a normal appearance. Thus, a vesicovaginal or urethrovaginal fistula is ruled out. (b) Intravenous urogram shows obstruction of the left ureter, which is likely due to a surgical clip (arrow). (c) CT urogram shows the fistula, which is faintly outlined by contrast material (arrowheads). (d) CT urogram shows resultant opacification of the vagina (V).

View larger version (156K): [in a new window]   Figure 7d.  Ureterovaginal fistula in a woman with a watery vaginal discharge. (a) VCUG image shows a normal appearance. Thus, a vesicovaginal or urethrovaginal fistula is ruled out. (b) Intravenous urogram shows obstruction of the left ureter, which is likely due to a surgical clip (arrow). (c) CT urogram shows the fistula, which is faintly outlined by contrast material (arrowheads). (d) CT urogram shows resultant opacification of the vagina (V).

View larger version (166K): [in a new window]   Figure 8.  Sigmoidovesical fistula secondary to diverticulitis. CT cystogram shows an air-fluid level in the bladder and contrast material in the colon, findings that suggest the diagnosis. Associated active diverticulitis is noted with bowel wall thickening (arrow). The affected section of the sigmoid colon is contiguous to the left posterior bladder wall, which appears focally thickened with obliteration of the fascial plane between the colon and the bladder. Air bubbles are noted along this connecting tract (arrowheads), thus highlighting the fistula.

View larger version (139K): [in a new window]   Figure 9a.  Sigmoidovesical fistulas as a complication of colonic adenocarcinoma in two patients. (a) Cystogram obtained by using a suprapubic catheter shows opacification of the sigmoid colon (S) and rectum (R) in addition to the bladder (B). The fistula is not clearly seen. (b) Cystogram shows contrast material throughout the large intestine. The contrast material originates at the sigmoid colon, which is contiguous to the bladder at the site of the carcinoma (arrow).

View larger version (151K): [in a new window]   Figure 9b.  Sigmoidovesical fistulas as a complication of colonic adenocarcinoma in two patients. (a) Cystogram obtained by using a suprapubic catheter shows opacification of the sigmoid colon (S) and rectum (R) in addition to the bladder (B). The fistula is not clearly seen. (b) Cystogram shows contrast material throughout the large intestine. The contrast material originates at the sigmoid colon, which is contiguous to the bladder at the site of the carcinoma (arrow).

View larger version (137K): [in a new window]   Figure 10a.  Ileovesical fistulas. (a) Cystogram of a patient with a history of abdominal surgery shows leakage of contrast material from the bladder (B) into the ileum (I) and proximal colon, thus indicating the diagnosis. (b) Image from a small-bowel follow-through study, obtained in a patient with a fistula due to Crohn disease, shows contrast material in the bladder (B), which is the key diagnostic finding.

View larger version (138K): [in a new window]   Figure 10b.  Ileovesical fistulas. (a) Cystogram of a patient with a history of abdominal surgery shows leakage of contrast material from the bladder (B) into the ileum (I) and proximal colon, thus indicating the diagnosis. (b) Image from a small-bowel follow-through study, obtained in a patient with a fistula due to Crohn disease, shows contrast material in the bladder (B), which is the key diagnostic finding.

View larger version (124K): [in a new window]   Figure 11a.  Rectovesical fistulas. (a) VCUG image of a patient with a history of prostatectomy for prostate carcinoma shows a fistula (arrow) with resultant rectal opacification (R). (b) CT cystogram enhanced with intravenous contrast material, obtained in a woman who had undergone suspension of the bladder neck with Dexon mesh (United States Surgical, Norwalk, Conn), shows leakage of contrast material out of the bladder, around the mesh (arrowheads), and into the rectum (R). Transvaginal removal of the mesh was necessary to close the fistula. (c) CT cystogram of another patient shows a fistula with contiguity of the posterior bladder and colonic walls, loss of fascial planes (arrowheads), and leakage of contrast material into the distal sigmoid colon (S) and rectum (R).

View larger version (184K): [in a new window]   Figure 11b.  Rectovesical fistulas. (a) VCUG image of a patient with a history of prostatectomy for prostate carcinoma shows a fistula (arrow) with resultant rectal opacification (R). (b) CT cystogram enhanced with intravenous contrast material, obtained in a woman who had undergone suspension of the bladder neck with Dexon mesh (United States Surgical, Norwalk, Conn), shows leakage of contrast material out of the bladder, around the mesh (arrowheads), and into the rectum (R). Transvaginal removal of the mesh was necessary to close the fistula. (c) CT cystogram of another patient shows a fistula with contiguity of the posterior bladder and colonic walls, loss of fascial planes (arrowheads), and leakage of contrast material into the distal sigmoid colon (S) and rectum (R).

View larger version (162K): [in a new window]   Figure 11c.  Rectovesical fistulas. (a) VCUG image of a patient with a history of prostatectomy for prostate carcinoma shows a fistula (arrow) with resultant rectal opacification (R). (b) CT cystogram enhanced with intravenous contrast material, obtained in a woman who had undergone suspension of the bladder neck with Dexon mesh (United States Surgical, Norwalk, Conn), shows leakage of contrast material out of the bladder, around the mesh (arrowheads), and into the rectum (R). Transvaginal removal of the mesh was necessary to close the fistula. (c) CT cystogram of another patient shows a fistula with contiguity of the posterior bladder and colonic walls, loss of fascial planes (arrowheads), and leakage of contrast material into the distal sigmoid colon (S) and rectum (R).

View larger version (154K): [in a new window]   Figure 12a.  Vesicourethral fistulas. (a) VCUG image shows a false urethral passage (arrow), which extends from the prostatic urethra to the base of the bladder and was created intentionally. (b) VCUG image obtained later shows that the fistula has become the dominant channel, whereas the prostatic urethra has closed. (c) VCUG image of another patient shows a spontaneously formed fistula, which was secondary to a urethral diverticulum (arrow).

View larger version (147K): [in a new window]   Figure 12b.  Vesicourethral fistulas. (a) VCUG image shows a false urethral passage (arrow), which extends from the prostatic urethra to the base of the bladder and was created intentionally. (b) VCUG image obtained later shows that the fistula has become the dominant channel, whereas the prostatic urethra has closed. (c) VCUG image of another patient shows a spontaneously formed fistula, which was secondary to a urethral diverticulum (arrow).

View larger version (129K): [in a new window]   Figure 12c.  Vesicourethral fistulas. (a) VCUG image shows a false urethral passage (arrow), which extends from the prostatic urethra to the base of the bladder and was created intentionally. (b) VCUG image obtained later shows that the fistula has become the dominant channel, whereas the prostatic urethra has closed. (c) VCUG image of another patient shows a spontaneously formed fistula, which was secondary to a urethral diverticulum (arrow).

View larger version (94K): [in a new window]   Figure 13a.  Vesicoarticular fistula secondary to pelvic trauma and complicated by an abscess and a septic joint. (a) VCUG image shows a fistula (arrow) from the bladder to the right hip. (b) CT image enhanced with intravenous contrast material shows an extensive abscess (A) of the right hip joint.

View larger version (117K): [in a new window]   Figure 13b.  Vesicoarticular fistula secondary to pelvic trauma and complicated by an abscess and a septic joint. (a) VCUG image shows a fistula (arrow) from the bladder to the right hip. (b) CT image enhanced with intravenous contrast material shows an extensive abscess (A) of the right hip joint.

View larger version (176K): [in a new window]   Figure 14a.  Causes and radiologic features of acquired urethrorectal fistulas in four patients. (a) Contrast-enhanced CT image shows a fistula (arrow), which was due to cryoablation of a prostatic carcinoma. Air pockets that extend to the urethra (arrowhead) are seen in the prostate. (b) Retrograde urethrogram shows leakage of contrast material into the rectum (R). The fistula was the result of radiation seed therapy in the prostate (arrowhead). (c) VCUG image of a patient with a prostatic abscess shows leakage of contrast material at the prostatic urethra (arrowheads) with opacification of the rectum (R). (d) VCUG image shows a fistula (arrow), which was a complication of transperineal prostatectomy.

View larger version (159K): [in a new window]   Figure 14b.  Causes and radiologic features of acquired urethrorectal fistulas in four patients. (a) Contrast-enhanced CT image shows a fistula (arrow), which was due to cryoablation of a prostatic carcinoma. Air pockets that extend to the urethra (arrowhead) are seen in the prostate. (b) Retrograde urethrogram shows leakage of contrast material into the rectum (R). The fistula was the result of radiation seed therapy in the prostate (arrowhead). (c) VCUG image of a patient with a prostatic abscess shows leakage of contrast material at the prostatic urethra (arrowheads) with opacification of the rectum (R). (d) VCUG image shows a fistula (arrow), which was a complication of transperineal prostatectomy.

View larger version (155K): [in a new window]   Figure 14c.  Causes and radiologic features of acquired urethrorectal fistulas in four patients. (a) Contrast-enhanced CT image shows a fistula (arrow), which was due to cryoablation of a prostatic carcinoma. Air pockets that extend to the urethra (arrowhead) are seen in the prostate. (b) Retrograde urethrogram shows leakage of contrast material into the rectum (R). The fistula was the result of radiation seed therapy in the prostate (arrowhead). (c) VCUG image of a patient with a prostatic abscess shows leakage of contrast material at the prostatic urethra (arrowheads) with opacification of the rectum (R). (d) VCUG image shows a fistula (arrow), which was a complication of transperineal prostatectomy.

View larger version (158K): [in a new window]   Figure 14d.  Causes and radiologic features of acquired urethrorectal fistulas in four patients. (a) Contrast-enhanced CT image shows a fistula (arrow), which was due to cryoablation of a prostatic carcinoma. Air pockets that extend to the urethra (arrowhead) are seen in the prostate. (b) Retrograde urethrogram shows leakage of contrast material into the rectum (R). The fistula was the result of radiation seed therapy in the prostate (arrowhead). (c) VCUG image of a patient with a prostatic abscess shows leakage of contrast material at the prostatic urethra (arrowheads) with opacification of the rectum (R). (d) VCUG image shows a fistula (arrow), which was a complication of transperineal prostatectomy.

View larger version (119K): [in a new window]   Figure 15a.  Urethroperineal fistulas in three patients. (a) Retrograde urethrogram shows a fistula (arrow), which was due to perineal trauma from a forklift accident. (b) Retrograde urethrogram of a patient with a prostatic abscess shows a large urethroperineal fistula. (c) VCUG image shows a fistula (arrowheads), which was created as a means of temporary urinary diversion as part of two-stage urethroplasty for anterior strictures.

View larger version (114K): [in a new window]   Figure 15b.  Urethroperineal fistulas in three patients. (a) Retrograde urethrogram shows a fistula (arrow), which was due to perineal trauma from a forklift accident. (b) Retrograde urethrogram of a patient with a prostatic abscess shows a large urethroperineal fistula. (c) VCUG image shows a fistula (arrowheads), which was created as a means of temporary urinary diversion as part of two-stage urethroplasty for anterior strictures.

View larger version (143K): [in a new window]   Figure 15c.  Urethroperineal fistulas in three patients. (a) Retrograde urethrogram shows a fistula (arrow), which was due to perineal trauma from a forklift accident. (b) Retrograde urethrogram of a patient with a prostatic abscess shows a large urethroperineal fistula. (c) VCUG image shows a fistula (arrowheads), which was created as a means of temporary urinary diversion as part of two-stage urethroplasty for anterior strictures.

View larger version (143K): [in a new window]   Figure 16.  Sigmoidovaginal fistula in a woman with a history of hysterectomy. Vaginogram shows a fistula involving the vaginal cuff (arrow). The vagina (V), sigmoid colon (S), and rectum (R) are highlighted by the contrast material.

View larger version (121K): [in a new window]   Figure 17a.  Urethrovaginal fistulas in four patients. (a) VCUG image shows a small fistula (arrow), which may be difficult to differentiate from a urethral diverticulum. (b) VCUG image shows a larger fistula, which is clearly demonstrated by contrast material in the vagina (arrow). The fistula is complicated by a urethral diverticulum (arrowhead). (c) VCUG image shows a very large fistula that has caused gross disruption of the urethrovaginal wall. (d) Intraoperative photograph shows a Foley catheter in the urethra that is visible from the vagina through the fistulous defect (arrow).

View larger version (128K): [in a new window]   Figure 17b.  Urethrovaginal fistulas in four patients. (a) VCUG image shows a small fistula (arrow), which may be difficult to differentiate from a urethral diverticulum. (b) VCUG image shows a larger fistula, which is clearly demonstrated by contrast material in the vagina (arrow). The fistula is complicated by a urethral diverticulum (arrowhead). (c) VCUG image shows a very large fistula that has caused gross disruption of the urethrovaginal wall. (d) Intraoperative photograph shows a Foley catheter in the urethra that is visible from the vagina through the fistulous defect (arrow).

View larger version (103K): [in a new window]   Figure 17c.  Urethrovaginal fistulas in four patients. (a) VCUG image shows a small fistula (arrow), which may be difficult to differentiate from a urethral diverticulum. (b) VCUG image shows a larger fistula, which is clearly demonstrated by contrast material in the vagina (arrow). The fistula is complicated by a urethral diverticulum (arrowhead). (c) VCUG image shows a very large fistula that has caused gross disruption of the urethrovaginal wall. (d) Intraoperative photograph shows a Foley catheter in the urethra that is visible from the vagina through the fistulous defect (arrow).

View larger version (127K): [in a new window]   Figure 17d.  Urethrovaginal fistulas in four patients. (a) VCUG image shows a small fistula (arrow), which may be difficult to differentiate from a urethral diverticulum. (b) VCUG image shows a larger fistula, which is clearly demonstrated by contrast material in the vagina (arrow). The fistula is complicated by a urethral diverticulum (arrowhead). (c) VCUG image shows a very large fistula that has caused gross disruption of the urethrovaginal wall. (d) Intraoperative photograph shows a Foley catheter in the urethra that is visible from the vagina through the fistulous defect (arrow).

View larger version (142K): [in a new window]   Figure 18a.  Fistulas of urinary diversion. (a) Neobladder-vaginal fistula due to creation of an ileal neobladder in a patient who underwent cystectomy for bladder cancer. Radiograph obtained after introduction of a catheter (arrow) into the vagina shows injected contrast material delineating the orthotopic bladder (B). In fact, the catheter tip appears to have entered the neobladder through the fistula, resulting in a transvaginal cystogram. (b) Ileal loop-perineal fistula in a patient who underwent total pelvic exenteration and urinary diversion to an ileal loop. Nephrostogram shows a fistula (arrowheads) extending from the ileal loop (L) into the perineum. Management of such fistulas involves percutaneous nephrostomy to divert urine from the fistula and may even require temporary or permanent ureteral occlusion.

View larger version (182K): [in a new window]   Figure 18b.  Fistulas of urinary diversion. (a) Neobladder-vaginal fistula due to creation of an ileal neobladder in a patient who underwent cystectomy for bladder cancer. Radiograph obtained after introduction of a catheter (arrow) into the vagina shows injected contrast material delineating the orthotopic bladder (B). In fact, the catheter tip appears to have entered the neobladder through the fistula, resulting in a transvaginal cystogram. (b) Ileal loop-perineal fistula in a patient who underwent total pelvic exenteration and urinary diversion to an ileal loop. Nephrostogram shows a fistula (arrowheads) extending from the ileal loop (L) into the perineum. Management of such fistulas involves percutaneous nephrostomy to divert urine from the fistula and may even require temporary or permanent ureteral occlusion.

View larger version (159K): [in a new window]   Figure 19a.  Cystography in diagnosis of vesicovaginal fistulas. (a) Lateral cystogram of a patient with vaginal leakage shows a fistula that originates at the high posterior aspect of the bladder wall (arrow), a common site of involvement. (b) Cystogram of another patient shows a very large fistula. B = bladder, V = vagina. (c) Correlative surgical photograph shows a gross defect through the vaginal wall (arrow), through which the bladder catheter can be seen (arrowhead).

View larger version (143K): [in a new window]   Figure 19b.  Cystography in diagnosis of vesicovaginal fistulas. (a) Lateral cystogram of a patient with vaginal leakage shows a fistula that originates at the high posterior aspect of the bladder wall (arrow), a common site of involvement. (b) Cystogram of another patient shows a very large fistula. B = bladder, V = vagina. (c) Correlative surgical photograph shows a gross defect through the vaginal wall (arrow), through which the bladder catheter can be seen (arrowhead).

View larger version (103K): [in a new window]   Figure 19c.  Cystography in diagnosis of vesicovaginal fistulas. (a) Lateral cystogram of a patient with vaginal leakage shows a fistula that originates at the high posterior aspect of the bladder wall (arrow), a common site of involvement. (b) Cystogram of another patient shows a very large fistula. B = bladder, V = vagina. (c) Correlative surgical photograph shows a gross defect through the vaginal wall (arrow), through which the bladder catheter can be seen (arrowhead).

View larger version (118K): [in a new window]   Figure 20a.  Cross-sectional imaging in diagnosis of vesicovaginal fistulas. (a) CT image obtained with excretion of intravenous contrast material into the bladder (B) shows a fistula, which is seen as a gross continuity between the bladder and the vagina (V). Air in the bladder (arrow) in the absence of catheterization also suggests the diagnosis. (b) In another patient, CT image enhanced with intravenous and oral contrast material shows an abscess of the rectovaginal pouch (A), which is indicated by leakage of contrast material (arrow) from the bladder into the abscess cavity and the vagina. Again, an air-fluid level is seen in the bladder. (c) Sagittal single-shot fast spin-echo MR image of another patient shows a vesicovaginal fistula (arrow), which is delineated by the hyperintense urine.

View larger version (123K): [in a new window]   Figure 20b.  Cross-sectional imaging in diagnosis of vesicovaginal fistulas. (a) CT image obtained with excretion of intravenous contrast material into the bladder (B) shows a fistula, which is seen as a gross continuity between the bladder and the vagina (V). Air in the bladder (arrow) in the absence of catheterization also suggests the diagnosis. (b) In another patient, CT image enhanced with intravenous and oral contrast material shows an abscess of the rectovaginal pouch (A), which is indicated by leakage of contrast material (arrow) from the bladder into the abscess cavity and the vagina. Again, an air-fluid level is seen in the bladder. (c) Sagittal single-shot fast spin-echo MR image of another patient shows a vesicovaginal fistula (arrow), which is delineated by the hyperintense urine.

View larger version (145K): [in a new window]   Figure 20c.  Cross-sectional imaging in diagnosis of vesicovaginal fistulas. (a) CT image obtained with excretion of intravenous contrast material into the bladder (B) shows a fistula, which is seen as a gross continuity between the bladder and the vagina (V). Air in the bladder (arrow) in the absence of catheterization also suggests the diagnosis. (b) In another patient, CT image enhanced with intravenous and oral contrast material shows an abscess of the rectovaginal pouch (A), which is indicated by leakage of contrast material (arrow) from the bladder into the abscess cavity and the vagina. Again, an air-fluid level is seen in the bladder. (c) Sagittal single-shot fast spin-echo MR image of another patient shows a vesicovaginal fistula (arrow), which is delineated by the hyperintense urine.

View larger version (142K): [in a new window]   Figure 21a.  Vesicouterine fistula. (a) CT cystogram shows leakage of contrast material from the posterior bladder wall into the uterus through a fistula (arrow). (b) CT cystogram obtained at a lower level shows passage of contrast material into the vagina (V). (c) A catheter was passed from the urethra and bladder into the endometrial cavity through the fistula. Radiograph obtained with antegrade injection of contrast material shows opacification of the bladder (B), endometrial cavity (E), cervical canal (arrow), and vagina (V).

View larger version (160K): [in a new window]   Figure 21b.  Vesicouterine fistula. (a) CT cystogram shows leakage of contrast material from the posterior bladder wall into the uterus through a fistula (arrow). (b) CT cystogram obtained at a lower level shows passage of contrast material into the vagina (V). (c) A catheter was passed from the urethra and bladder into the endometrial cavity through the fistula. Radiograph obtained with antegrade injection of contrast material shows opacification of the bladder (B), endometrial cavity (E), cervical canal (arrow), and vagina (V).

View larger version (135K): [in a new window]   Figure 21c.  Vesicouterine fistula. (a) CT cystogram shows leakage of contrast material from the posterior bladder wall into the uterus through a fistula (arrow). (b) CT cystogram obtained at a lower level shows passage of contrast material into the vagina (V). (c) A catheter was passed from the urethra and bladder into the endometrial cavity through the fistula. Radiograph obtained with antegrade injection of contrast material shows opacification of the bladder (B), endometrial cavity (E), cervical canal (arrow), and vagina (V).