Fistula Flashcards
(30 cards)
What is a fistula?
An abnormal communication between two epithelial surfaces.
What is vesicovaginal fistula (VVF)?
Continuous leakage of urine through the vagina that cannot be voluntarily controlled.
What is rectovaginal fistula (RVF)?
Intermittent passage of stool from the vagina, which can be cleaned and temporarily controlled.
How does the social impact of VVF compare to RVF?
VVF is more socially stigmatising and less acceptable.
What is the global backlog of VVF cases?
About 2 million globally, with most awaiting surgery.
What is the annual incidence of VVF in Africa?
100,000–150,000 new cases annually.
What is the incidence of fistula in Nigeria?
200,000 backlog; ~12,000 new cases annually; incidence: 2–5 per 1000 deliveries.
What percentage of cases are isolated VVF?
0.85
What are common causes of obstetric fistulas?
Prolonged obstructed labour, surgical trauma, infection, radiation, operative deliveries.
What is pressure necrosis in the context of fistulas?
Tissue death due to compression between bony pelvis and foetal head.
What are some surgical causes of fistulas?
Caesarean section, hysterectomy, forceps delivery, symphysiotomy.
What infections can lead to fistulas?
Lymphogranuloma venereum, radiation for cervical cancer.
What is a conservative management strategy for early urinary fistula?
Indwelling catheter for 6 weeks, correction of anaemia and sepsis, psychological support.
What are the benefits of early management of fistula?
Tissue healing, inflammation resolution, better surgical outcome.
How do VVF and UVF differ in presentation?
VVF: total urinary incontinence; UVF: partial urinary incontinence.
What is a common neurological complication seen with fistula?
Foot drop from peroneal nerve damage.
What physical signs might be seen in a patient with fistula?
Vulval excoriation, anaemia, infection, poor nutritional status.
What basic investigations should be done for fistula evaluation?
Hb, serum urea, urine MCS, chest X-ray, IVU, pelvic X-ray.
How are fistulas classified by size?
Small <2cm, Medium 2–3cm, Large 4–5cm, Extensive ≥6cm.
Name three anatomical locations of VVF.
Juxta-urethral, mid-vaginal, juxta-cervical.
What is the Kees Waaldijk classification of fistulas?
Type I: not involving closing mechanism; Type II: involving it (subtypes A/B, with/without circumferential defect); Type III: miscellaneous (e.g., ureteric).
What are the goals of pre-operative care for fistula repair?
High protein diet, iron supplementation, deworming, infection treatment, vulval skin care.
What are the surgical goals during fistula repair?
Close fistula without tension; separate vagina and bladder walls; repair in layers; grafts or diversion if needed.
What are the post-operative care steps after VVF repair?
Catheter drainage (10–14 days), antibiotics, bladder drill, perineal hygiene, prevent constipation.
