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Genito-Urinary Fistulas
Genito-Urinary Fistulas
Genito-Urinary Fistulas
FISTULAS
Definition
Abnormal communications between urinary
& genital organs.
Remember 2 golden rules
1st rule: urine may escape from
ureter tube, uterus, cervix, vagina
bladder tube, uterus, cervix, vagina
urethra always vaginal.
2nd rule in naming a fistula,
Part of the urinary tract is 1st to be described
Varieties
1. Vesico-vaginal
2. Uretero-vaginal
3. Urethro-vaginal
4. Vesico-cervical
5. Uretero-cervical
6. Uretero-uterine
VESICOVAGINAL FISTULA
(The Commonest)
etiology
Congenital: very rare.
Traumatic fistula
Obstetric trauma
Surgical trauma
Direct trauma
Inflammatory disease
Malignant neoplasms
Radiation necrosis
Necrotic Obstetric Fistula
Prolonged compression of soft tissues between
head & brim of a narrow pelvis.
→ ischaemia, pressure necrosis & sloughing of
base of the bladder.
Urethra is also often involved.
Slough takes some days to separate
→ Incontinence develops 5-7 days after labour
Such fistulae are often surrounded by dense
fibrosis
Traumatic Obstetric Fistula
Direct injury to bladder wall by sharp
instrument (perforator or decapitation hook)
during a difficult labour
Forceps rarely cause it
Incontinence Appears immediately After
Labour
Traumatic Fistula
Surgical trauma: Bladder may be injured
during vaginal operation as anterior
colporrhaphy
during abdominal operations as hysterectomy.