Gynaecological Fistulas Max Brinsmead MB BS PhD May 2015

Sites of Urine Leakage through the Vagina  Vesico vaginal fistula i.e. from bladder  Uretero vaginal fistula i.e. from ureter  Urethro vaginal fistula i.e. from urethra Can be clinically distinguished with Methylene dye in the bladder and 3 swabs along the length of the vagina  Or  Cystoscopy and IVP

Causes of Urinary Fistula  Obstetric injury In 3 rd world countries it is obstructed labour and bladder necrosis In 1 st world countries it is LSCS and unrecognised bladder or ureteric damage  Gynaecological injury Hysterectomy – bladder or ureter Incontinence repair – urethra  Malignancy Bladder or cervix  Radiotherapy  Congenital  Trauma

Management of Urinary Fistula  For small lesions: Bladder catheter or ureteric stent Wait for spontaneous closure  For larger lesions: Wait until “healed” Then close from below or above 3-layered closure Bladder catheter or ureteric stent

Causes of Bowel Fistula  Obstetric injury 4 th degree tears  Gynaecological injury Posterior repair  Malignancy Rectum or cervix  Radiotherapy  Inflammatory Bowel Disease e.g Crohns  Congenital

Management of Faecal Fistula  May require a diversionary colostomy  Must treat the underlying problem when there is inflammatory disease or cancer  May also require anal sphincter repair

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