Genital fistulas in females (Undergraduate)

1. Genitourinary Fistula
Undergraduate
Dr/ Ahmed Walid Anwar Morad
Assistant professor of OB/GYN
Benha University
2017

2. Genitourinary Fistula
Def: Abnormal communication between
urinary and genital tract.

3. Classification
• Number:
• Single
• Multiple
• Level
• Low
• Mid
• High
• Complication
• Complicated: poor access, scared tissue
• Non-complicated: good access, good tissues

6. Diagnosis
• History:
– History of the cause.
– C/O:
– Urine Incontinence:
– Type: partial or complete
– Time of incontinence:
» Necrotic fistula: after 1 week
» Direct fistula: immediately
» Radiation fistula: after months
– Pruritis vulvae
– Amonical smell
– Psychological disturbances

7. Diagnosis
• General: pyelonephritis± uremia manifestations.
• Abdominal: scar, renal mass, tenderness.
• Local:
– Inspection:
• Vulvitis
• Phosphate encrustation.
• Large fistula easily seen.
– Digital palpation: small fistula is surrounded by
fibrosis.
– Speculum examination : in Sims position to show…
Size, site, level of fistula & extent of fibrosis.

8. Sims' position

9. • Special tests:
1. Catheter test: comes out from vaginal
orifice of vagina.
2. Click test: metal catheter in bladder gives
click with metal probe passes through
vaginal orifice of fistula.
3. Methylene blue test:
4. Modified methylene blue test: no pads but
dye is observed directly…. Level & number.
5. Double dye test: after methylene blue test.
Diagnosis

10. Methylene blue test

11. Methylene blue test

12. Investigations
• Complete urine analysis.? (catheter, close fistula, special
vaginal receptacle)
• Kidney function tests.

15. Various surgical approaches
Vaginal Abdominal
Indications:
Simple, low ,easy accessible
Methods
•Flap splitting operation
•Sauccerization
•Latizko ( partial colpoclesis)
•Repair and graft
Indications:
Multiple ,large, complicated
,recurrent, related to ureter,
vault, associated with pelvic
pathology
Methods
Transperitoneal
,trans/intravesical with
graft

19. Postoperative care
• Rest.
• Excess fluids.
• Drugs: antibiotics , urinary antiseptics,&
acidification of urine.
• Vaginal pack: 24h
• Urinary catheter: 10 days
– After removal of catheter: avoid bladder over
distention by voiding:
• Every 2h by day
• Every 4h by night

24. • Vesicouterine fistula: cyclic haematuria (Yousef syndrome).
• Urethrovaginal fistula: double stream urine.

26. Rectovaginal Fistula
• Def: abnormal communication between
rectum and vagina.

27. Diagnosis
• Symptoms:
• Large fistula: incontinence to flatus, liquid stool and
hard faeces.
• Small fistula: incontinence to flatus and liquid stool.
• Foul smelling vaginal discharge.
• Vulvitis &vaginitis.
• Signs:
• Inspection: Direct visualization
• Palpation: Digital palpation for fibrosis
• Investigations:
• MB Test
• Ba enema
• Proctosigmoidoscopy

29. 1) RVF IN lower 1/3 of vagina
• Lawson Tait‘s operation

30. 2) RVF IN middle 1/3 of vagina
• Flap splitting as VVF.
• Start as rectocele repair and extend
dissection above the fistula.
3) RVF IN upper 1/3 of vagina
•Abdominal approche
Latzko operation

31. Postoperative care
• Early:
– Rest
– Diet
• Low residue diet
• Excess fluids
– local care:
• vaginal pack: 24h
• Antiseptics wash of the vulva after every micturition.
– Drugs
• Antibiotics, analgesics, laxatives
• Intestinal antiseptics
• Late : elective CS in subsequent delivery

32. Thank You
Any Questions or
Comments?