| ID | 318 |
|---|---|
| Name | UROGENITAL FISTULA |
| Cause | Causes: 1. Obstructed labour 2. During forcep delivery & craniotomy. 3. Rupture uterus 4. During operation- e.g Wertheim’s hysterectomy, Fothergill’s operation. 5. Foreign body in the vagina- e.g I.U.C.D. |
| Signs Symptoms | Constant urine leakage or urinary incontinence. Chronic urine odor. Skin irritation in your vagina, vulva (vaginal entrance) or perineum (area between your vagina and anus). Painful intercourse (dyspareunia). |
| Diagnosis | A urine sample, which will identify infections or other problems in the urinary tract\ The most common tests would be an X-ray of the pelvis, or a computed tomography (CT scan) that uses dye (also called contrast) to highlight the tissues in that part of the body, making it easier to identify the source of the problem |
| Investigations | Investigation: 1. To confirm diagnosis- 3 swab tests. 2. IVU- for hydronephrosis 3. Urine for R/M/E & C/S 4. Renal function test |
| Management | Most fistulas require surgical repair. The type of surgery is determined by the location of the fistula, done either through the abdomen or vagina. Depending on location and size of the fistula, minimally invasive options — including robotic surgery for urinary fistula |
| Introduction | It is an abnormal communication between the genital tract & urinary tract lined by granulation tissue. Vesico-vaginal fistula (V.V.F) is the most common variety. |
| History | |
| Etiology | see under causes |
| Clinical Features | Clinical feature: Symptoms: 1. Continuous dribbling of urine per vagina 2. No urge or desire for micturition 3. History of difficult child birth. Signs: On general exam-Clothing will be found wet & smell of urine from the body. Vulva is moist & there is excoriation of the skin and itching. P/Vexam- If fistula is large- obviously seen by speculum. If fistula is small- it can be felt per vaginally by using metalic catheter. Rectal exam-It should be done to exclude rectovaginal fistula and perineal tear, if any. |
| Preventions | |
| Treatment | Treatment: Surgery is the treatment of choice. 1. Local repair- - flap splitting method - saucerization - colpocleisis (partial or total) 2. Urinary diversion- - uretero colic anastomosis - isolated rectal pouch - isolated ilial loop of conduit |
| Complications | Post-operative complications: 1. Cystitis 2. Breakdown of the wound leading to leakage of urine. 3. Blockage of the catheter. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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