Pelvic Fistula Specialist
Dr. Daniel Stone, MD FACOG
Urogynecologist located in Phoenix, AZ
Dr. Daniel Stone, MD is one of the leading experts in the surgical management of pelvic fistulas. Dr. Stone can diagnosis and provides management options for pelvic fistulas to patients in the Phoenix, Scottsdale and surrounding Arizona areas. By correcting this extremely bothersome condition, women can get back to their normal life.
Pelvic Fistula Q&A
What is a Fistula and what are the different types of pelvic fistulas?
Fistulas are an abnormal connection between two body parts that aren’t normally connected. These divided into the following groups:
- Genitourinary Fistulas
- Vesicovaginal – Connection between the bladder and vagina.
- Urethovaginal – Connection between urethra and vagina.
- Vesicouterine – Connection between bladder and uterus.
- Vesicocervical – Connection between bladder and cervix.
- Ureterovaginal - Connection between the ureter and vagina.
- Rectovaginal Fistulas – Connection between the rectum and vagina
- Colovaginal Fistulas – Connection between the colon and vagina. These fistulas are treated by colorectal surgeons.
- Genitourinary Fistulas
What are the symptoms of a Pelvic Fistula?
- Genitourinary fistulas present as constant urinary leakage from the vagina.
- Rectovaginal fistulas present as accidental bowel leakage from the vagina, air escaping from the vagina, vaginal infections, or bad-smelling vaginal discharge.
Why do Fistulas form?
They form due to damage to the tissue. Depending on the cause of this tissue damage, fistulas can form within days to years. The causes of pelvic fistulas are listed below:
- Childbirth – A long labor can lead to tissue damage and fistulas. This can lead to rectovaginal, vesicovaginal or urethrovaginal fistulas. This is rarely seen in the United States but the most common cause of fistula worldwide.
- Surgery - Pelvic fistulas can be a complication of pelvic surgery including hysterectomies, and reconstructive vaginal surgery.
- Cancer – fistulas can occur due to cancer itself or due to radiation that is used to treat cancer. These types of fistulas are very difficult to treat due to the poor tissue quality caused by the radiation.
- Foreign Bodies - Any type of foreign body that is left in place can lead to tissue damage and fistula formation. Pessaries, when left in place for a long time, can lead to fistulas in rare circumstances.
- Chronic bowel conditions: Diverticulitis or inflammatory bowel disease (Crohns or Ulcerative colitis) can lead to tissue damage and fistula formation. Although Dr. Stone can assist in the diagnosis of fistulas, he does not treat fistulas due to chronic bowel conditions and instead would set you up with a colorectal surgeon and GI doctor.
How are Genitourinary Fistulas diagnosed?
Dr. Stone will ask you about your symptoms and when they started and then perform a pelvic exam. Sometimes he may place special dyes into the bladder to determine where the leakage is coming from. He may recommend other tests as well such as a cystoscopy or CT scan.
How are Genitourinary Fistulas treated?
Depending on the size, location, and reason for the fistula, Dr. Stone will discuss different options with you. If the fistula is small, the placement of a catheter for 4-6 weeks may help the fistula to close on its own. A ureterovaginal fistula is present, a ureteral stent can help with healing.
If those options don’t work, or it is a large fistula, then surgery would be required. 95% of Dr. Stone’s surgeries result in a successful resolution of the fistula. Surgery can be done vaginally, or robotically depending on the location of the fistula. After surgery, you will need a urinary catheter for 2 weeks.
How are Rectovaginal Fistulas diagnosed?
Dr. Stone will ask you about your symptoms and when they started and then perform a pelvic exam. Dr. Stone may use dye to help see the fistula if it is small. Sometimes a small metal probe is used to locate the fistula if it is hard to find. Occasionally, Dr. Stone will order and perform a transanal ultrasound to determine if the fistula involves the anal sphincters.
How are Rectovaginal Fistulas treated?
Depending on the cause, size, and location, Dr. Stone will discuss several options with you. If the cause of the injury was recent, he may discuss watching and waiting to see if the tissue can heal with time. If you have inflammatory bowel disease, medications can help with healing and reducing inflammation.
If a surgical treatment is decided on, Dr. Stone performs this surgery vaginally. The surgery involves removing the fistula tract and bringing together the different layers of tissue. Sometimes, Dr. Stone will use a graft from the surrounding tissue to help with healing.
Major Insurance Providers Accepted
We accept most insurance policies for your convenience. Please contact your insurance carrier to verify your individual benefits and any copays or coinsurance that are part of your plan. Patients are responsible for notifying our office if a specific plan requires precertification, preauthorization, or a referral (especially HMOs). Please call the phone number on the back of your insurance card to verify your provider network participation as insurance carriers change policies often.
Phoenix, Arizona 85016-1302
Office Hours: Monday-Friday from 8 AM – 5 PM
Main: (602) 788-1521
Fax: (602) 688-5420
Conveniently located just off Highway 51 on Maryland Avenue just East of 16TH Street between East Bethany Home Road and East Glendale Avenue.