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Flashcards in Fistula Deck (10)
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1

Definition vesicovaginal fistula

Abnormal passageway between the bladder and vagina that causes urinary incontinence and leakage

2

Causes of vesicovaginal fistula

Obstetric:
- Obstructed Labour
- Forceps/instrumental
- Injury at time of CS
- Uterine rupture

Surgical:
- Hysterectomy
-Urogynae surgery

Radiation for malignancy

Malignancy
- Most common: cervical, vaginal and endometrial

Congenital:
- E.g. VATER/VACTERL

Other:
- Infection
- Inflammation
- Foreign body
- Trauma/sexual assault

3

Presentation of vesicovaginal fistula

- Continuous leaking of urine- may just be a watery discharge
- Incontinence

4

Diagnosing vesicovaginal fistula

- Examination- fistula may be visible
- 'Tampon test' - fill bladder with methylene blue. Insert a tampon into the vagina. If tampon blue then = fistula
- Cystoscopy
- Intravenous pyelogram
- CT/MRI

5

Treating vesicovaginal fistula

Conservative:
- Oestrogen into the vagina to strengthen vaginal tissue
- Foley catheter

Surgical:
- Minimally invasive: Occlusion with laser, electrocautery or glue
- Surgical repair with either transvaginal, abdominal or laparoscopic approach (usually delay by 3-6/12)

6

Definition rectovaginal fistula

Abnormal connection between rectum and vagina causing stool to leak from the rectum into the vagina

Can be 'low' - ie at entrance to vagina (e.g. OASIS) or high- ie n upper vagina near cervix (e.g. malignancy) can also be simple or complex

7

Causes of rectovaginal fistula

Obstetric:
- Obstructed Labour
- Forceps/instrumental
- 3rd or 4th degree tear
- Infected episiotomy

Crohn's disease

Surgical:
- Hysterectomy
-Urogynae surgery or other surgery involving rectum, vagina, anus, perineum

Radiation for malignancy

Malignancy
- Most common: cervical, vaginal, endometrial, rectum, anus

Other:
- Infection
- Inflammation
- Foreign body
- Trauma/sexual assault

8

Symptoms of rectovaginal fistula

- Passage of gas, stool or pus from the vagina
- A foul-smelling vaginal discharge
- Recurrent vaginal or urinary tract infections
- Irritation or pain in the vulva, vagina and perineum
- Dyspareunia

9

Investigations for rectovaginal fistula

- Dye in the vagina, bladder or rectum to find all signs of leakage
- Urinalysis to check for infection
- Blood test to check for signs of infection
- CT or MRI
- Anorectal ultrasound to evaluate the structure of the anal sphincter and show defects caused by obstetric injury

10

Treatment for rectovaginal fistula

- Ensure any infection/inflammation clears
- Often try to wait 3-6/12 to allow for healing
- Seton drain

Surgical:
- Endorectal advancement flap, with or without sphincteroplasty
- Episioproctotomy with reconstruction of the ano-rectalvaginal septum
- Martius flap