Genitourinary Fistulas

4 is very very rare. also lcsc is dne with great deligence now also.

because to clear out adhesions etc might actually damage the region between the vagina and the bladder

if big fistula then wont be able to hold urine but if small fistula then can hold urine and pass normally as well.

how to diagnose fistulas from clinical presentation? DD it from stress inconticense ad stuff? How do the dfferent fistulas present...difference in terms of dribbling? ability to hold urine? ability to pass urine? continious vs on stress. must be able to work out these!

onstretcic and surgical and also congenital?

if big will be able to see fistula opening. and is smaller then will be able to feel it...and in any case it will be pooling on the speculum.

urine cuture needs to be done because musnt do surgery if its infected!!!!!

can repair it by the vaginal route or by the adbominal route.

the operation is basically to destroy the fistula and then sticth the vagina and bladder seperately

so that wehn it heals they heal sepearttely.. two different healing procedures

so it cannot be done when the area is alsready inflammed and healing.

so during delivery, the repair should be done immeidtely or then 6 weeks after..that is repaired after puerperium.

but it isnt done immedately after because obstrectic injuries leading to vesicoveginal fistulas are diagnosed later. so the time window is lost.

then the woman is told to put the pad up and wait for six weeks and then only the operation is done to fix the fistula.

how to come to the diagnosis of different types of fistulas?

if its d will be able to hold urine! and urinate normally .....but will also have contiuous dribbling.

think about the different fistulas and the clinicl presentation.

three swab test is only done if cant see the fistula and visualise it and if theres a possibility of urethra-vaginal fistula. But in this case it cant be a urethravaginal because in the latter will be able to hold urine and pass out urine nromally with irge.

just that it will come out from the vagina and hecne woud lead to frequent uti and vaginal infection?

What if theres both kinds of fistulas?

if theres a small vesocovaginal then it can lead to both continoous dribbling and also holding and passing out normally?

of all 3 swabs was stained it can still be all 3!

The first most common site is waterunder the bridge it's the cardinal ligamets are cut as close to the cervix as possibleas if cut latreally it encounters the artery and ureter as well…sometimes the artery bleeds here and needs to be ligated and sutured here so that can lead to mistakenly cuttiing the uereter

but it radical hysterectomy it has to be cut wider and so it has more chances of damaging the ureter

and also if the ovum is meant to be removed out, then the infundibulopelvic ligament should be cut and that’s near the pelvic brim where it encounters the ureter and pelvic vessel bifurcation..so that’s the second most common site

the green is the infundibulopelvic ligament

if its a mistae done etc then can take the help of a urosorgeon to fix things up. Or if its going to be a very hard surgery then can take the help of a urosurgeon to put stents in to identify the ureter so wont have any mistakes....esepciallly when there's a lot of adhesion setc.

The below is how ligation of the ureter usually presents like :

For the above choose the latest time.

The below is another method to prevent fistula formation. esepcially in high risk of vvf in cs with obstructed labour!

After surgery of high risk ways to know whether there has been a fistula made or not ? 1. using cystoscopy and visualising the badder and seeng whether there are any holes seen 2 putting blue dye retrogradely and seeing whether theres any leakage of dye.

then any fistula fund can be repaired there and then itself. otherwise have to wait 2-3 months until inflammation has subsided.

Fistulas should be dd from incontinence and from trauma Urologists can treat these in both males and females. Urological surgeons