Fistula Ug
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Transcript of Fistula Ug
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UROGENITAL FISTULAS
Dr. St. Nur Asni, SpOG
Division of Urogynecology
Department of Obstetrics and Gynecology
School of Medicine, University of Hasanuddin
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DEFINISI
Urogenital Fistulas is an abnormalfistulous tract extending between thebladderand the vaginaor uterus thatallows the continuous involuntary
discharge of urineinto the vagina
http://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/images/ency/fullsize/19291.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_imagepages/19291.htm&h=320&w=400&sz=30&tbnid=1bmx8q7Y6CIJ:&tbnh=96&tbnw=120&start=1&prev=/images%3Fq%3Dfistulas%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DGhttp://en.wikipedia.org/wiki/Urinary_bladderhttp://en.wikipedia.org/wiki/Vaginahttp://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/images/ency/fullsize/19291.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_imagepages/19291.htm&h=320&w=400&sz=30&tbnid=1bmx8q7Y6CIJ:&tbnh=96&tbnw=120&start=1&prev=/images%3Fq%3Dfistulas%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DGhttp://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/images/ency/fullsize/19291.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_imagepages/19291.htm&h=320&w=400&sz=30&tbnid=1bmx8q7Y6CIJ:&tbnh=96&tbnw=120&start=1&prev=/images%3Fq%3Dfistulas%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DGhttp://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/1060fistula-8.jpg&template=izoom2http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/1060fistula-8.jpg&template=izoom2http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/1060fistula-8.jpg&template=izoom2http://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/images/ency/fullsize/19291.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_imagepages/19291.htm&h=320&w=400&sz=30&tbnid=1bmx8q7Y6CIJ:&tbnh=96&tbnw=120&start=1&prev=/images%3Fq%3Dfistulas%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DGhttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Vaginahttp://en.wikipedia.org/wiki/Urinary_bladderhttp://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/images/ency/fullsize/19291.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_imagepages/19291.htm&h=320&w=400&sz=30&tbnid=1bmx8q7Y6CIJ:&tbnh=96&tbnw=120&start=1&prev=/images%3Fq%3Dfistulas%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DG -
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INSIDENS
Developing countries:
Most are due do totraumatic injury
USA: Ginecologicinjury
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ETIOLOGYI
Obstetric injury
Operative injury
gynecologic surgery Radiation therapy
Urologynecologic procedure
Non surgical causes : pelvic infection,bladder stone, pelvic trauma
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OBSTETRIC INJURY
when a prolonged labor presses theunborn child tightly against thepelvis, cutting off blood flow to thevesicovaginal wall. The affectedtissue may [[necrosis|necrotize]],leaving a hole.
Forceps delivery, cesarean section,
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Gynecologic surgery
Histerektomi transabdominal
Histerektomi transvaginal
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Classification
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Classification of vesicovaginal fistulasSimple
Fistula is less than 2 to 3 cm in size and near the cuff(supratrigonal)
Patient has no history of radiation or malignancy
Vaginal length is normal
Complicated
Patient has had previous radiation therapy
Pelvic malignancy is present
Vaginal length is shortened Fistula is greater than 3 cm in size
Fistula is distant from cuff or has trigonalinvolvement
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Location of lower urinary tract structures
A. middle third
B. upper thirdC. of the vagina
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Diagnosis
Metilen Blue Test/ Intravesical dyetest
Vaginal tampon test
Flat tyre test Urograms
Cystourethroscopy
Hysterograms
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Management Small fistulas heal spontaneously Surgical principles for genitourinary fistula closure
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Operative
Futh Mayo procedure
Sims-Simon procedure
Latzko Colcopcleisis procedure Martius Bulbocovernosus Flap Plasty
procedure
Abdominal repair for complex fistula.
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Martius Flap
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