Genital fistula
These r abnormal epithelialised communication tracts betn genital and urinary tract or elementary or both
C/f
- presents with complaints of conastant dribbling of urine
- constant wetness in genital area leads to excoriation of vagina, vulva
- vvf at the bladder neck region following difficult child birth is common
- woman of obstretic fistula is with short stature with contracted pelvis
- positive methylene blue test confirms diagnosis
Investigation:
- urine cuture
- sonography
- descending pylography
- cystoscopy with idigocarmine excretion test
- ureteric catheterisation
- methylene blue 3 swap test
Management:
- shuld be repaired vaginaly Latzko's procedure of denuding vaginal epithelium, freshning the edge and approximating wide raw surfaces
- Chassar Moir technique: widely separating the vagina and bladder by the flap splitting method
- if first attempt fails second is undertaken aft 3 months
- for urinary divesion like implantation of ureters into sigmoid colon, creating an ileal loop bladder into which ureters r implanted, distal end of rectosigmoid is sutured and closed. Ureters implanted into rectal pouch
- postoperative mx: continuous bladder drainage for 14 days
- antibiotics
- no vaginal or speculum exm or intercourese for 3 months aft surgery
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