Genitourinary fistulasDr. shruti verma DR. SHRUTI VERMA

Definition

1.2.

A fistula is an abnormal communication between two or more epithelial surfaces. GENITOURINARY FISTULA is an abnormal communication between urinary and genital tract, either acquired or congenital with involuntary escape of urine into the vagina. Urine leaks from From ureter or bladder uterus, cervix, vagina From urethra vagina only

Types

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1. 1. 2. 3.

Bladder Vesicovaginal Vesicourethrovaginal Vesicouterine Vesicocervical Urethra Urethrovaginal Ureter Uretrovaginal Uretrouterine uretrocervical

etiology

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OBSTETRICAL Ischemic: 3-5 days following delivery Traumatic: instrumental vaginal delivery/ abdominal surgery, follows soon after delivery

1. 2. 3.

GYNAECOLOGICALOperative: ant colporraphy, TAH Traumatic: fall, #pelvis, forgotten pessary Malignancy: cervical, vaginal, bladder Radiation Infection: TB, LGV

4.5.

TYPES

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DEPENDING UPON TISSUE CONDITION Simple: healthy tissues, good access Complicated: tissue loss, scarring, difficult access, associated with RVF DEPENDING UPON SITE Juxtacervical Midvaginal Juxtaurethral subsymphysial

symptoms 1. 2. 3. 4. 5. 6.

Usually a young primipara with h/o difficult labour or instrumental delivery Continuous escape of urine per vaginum Large: No urge to urinate Small: incontinence in certain positions and can also pass urine normally Obstetric: after 7-14 days Operative injury: first post op day Post radiation: months or years later Urethral: (high up): stress incontinence

menouria: in vesico cervical and vesico uterine: , may hold urine at the level of isthmus and remain continent, present with cyclical hematuria Recurrent cystitis Perineal skin irritation: due to constant wetness and vaginal fungal infection Secondary amenorrhoea: hypothalamic origin (corrected after repair) Psychosocial dysfunction: pt is outcast, abandoned, may suffer from depression, anxiety

Aims of evaluation

Site Size Number Fibrosis and scarring Recurrence Involvement of uretric orifices Involvement of sphincteric mechanism Associated vagino-rectal fistula

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5.6. 7. 8.

Good prognostic factors Single VVF>RVF or mixed Size