GENITO-URINARY FISTULA - TYPES, CAUSES, S/S, DIAGNOSIS, TESTS .pptx

GENITO-URINARY FISTULA -
TYPES
CAUSES
SIGNS AND SYMPTOMS
SIMS POSITION
DIAGNOSIS
DYE TEST
THREE SWAB TEST
METAL CATHETER TEST
URETHRO-VAGINAL FISTULA
Genito-urinary fistulas, particularly vesicovaginal fistulas (VVF), are pathological communications between the bladder and the vagina, often leading to continuous urinary leakage. These conditions are frequently associated with obstetric trauma, especially in regions with limited access to maternal healthcare. Other causes include surgical complications, radiation therapy, or malignancies affecting the pelvic region.

VVFs primarily occur due to prolonged obstructed labor, leading to tissue ischemia and necrosis between the bladder and vaginal walls. This is more common in low-resource settings where access to timely cesarean sections is limited. Surgical repair is the mainstay treatment, with varying approaches such as vaginal or abdominal fistula repairs, depending on the size and complexity of the fistula.

Recent research has focused on improving surgical outcomes and reducing recurrence rates. Advances in tissue engineering and regenerative medicine are being explored for better healing and restoration of the affected tissues. Additionally, research into less invasive methods, such as the use of fibrin glue or mesh, offers promising alternatives to conventional surgery.

Efforts to reduce VVF incidence globally emphasize better access to maternal care, education, and skilled birth attendance. However, the successful prevention and treatment of genito-urinary fistulas still depend on broader socio-economic improvements and healthcare access, especially in low-income countries.

For the latest and detailed research, you might explore recent publications in medical journals related to obstetrics and gynecology...

1. TOPIC: GENITOURINARY FISTULA BY: DR. MD SANEN S BHMS 2019-BATCH AMSHMC BELGAUM INTER-DEPARTMENTAL INTEGTATION ( OB-GYN AND SURGERY )

2. GENITOURINARY FISTULA A Fistula is an abnormal communication between two or more epithelial surfaces. The cause usually is an abscess. Genitourinary Fistula is an abnormal communication between the urinary and genital tract. They are either acquired or congenital with involuntary escape of urine into the vagina.

3. Types of Genito urinary Fistula Bladder Vesicovaginal ( most common) Vesicourethrovaginal Vesicouterine Vesicocervical Urethra Urethovaginal Ureter Ureterovaginal Ureterouterine Ureterocervical Vesicoureterovaginal

4. TYPES Vesicovaginal Vesicourethovaginal Urethrovaginal Vesicocervical Ureterovaginal Vesicouterine

5. TYPES

6. 1 . Vesicovaginal Fistula (VVF) It is defined a communication between the bladder, the vagina. The urine escapes into the vagina causing true incontinence. This is the most common type of genitourinary fistula. Aetiology : 1. Congenital ( very rare ) 2. Obstetrical 3. Gynecological

7. Vesicovaginal Fistula

8. Ischemic: Results from prolonged compression on the bladder base between the head of the fetus and symphysis pubis. Following delivery, it takes a 2-3 days to produce such type of fitula . In obstructed labor -> ischemic necrosis -> infection -> sloughing - > Fistula Traumatic: 1. Instrumental vaginal delivery 2. Abdominal operation like hysterectomy, cesarean section. Obstetrical Causes

9. Obstetrical Causes Episiotomy: Is an incision made on the perineum and post vaginal wall during 2 nd stage ( just prior to crowning).

10. Obstetrical Cause

11. Gynecological Causes Operative injury: Anterior Colporrhaphy , Abdominal Hysterectomy Traumatic: Fall on a pointed object, Fracture of pelvic bones, Stick used for criminal abortion, Retained or forgotten pessary . Malignancy: Advanced carcinoma of cervix, vagina, bladder. Infective: Vaginal tuberculosis, lymphogranuloma venereum , schistosomiasis .

12. Simple Complex Healthy tissue with good access. 2-3 cm in size. Located in upper part of vagina. Normal vaginal length Supratrigonal . Tissue loss, scarring, difficult access, associated with RVF Less than 3cm Located in mid vagina Vaginal length shortened Trigonal area Types of VVF

13. Types: Depending upon the site of the fistula. Juxtacervica l : Between the supratrigonal region of bladder and the vagina. Midvaginal : Between the trigone of the bladder and vagina.

14. Types: Depending upon the site of the fistula. 3. Juxtaurethral : Between the neck of the bladder and vagina. 4. Subsymphsial : circumferetial loss of tissue in the region of neck of bladder and urethra. The margine is fixed to the bone.

15. Symptoms Continuous escape of urine per vagina. Gets urge but urine dribbles out into the vagina. Secondary amenorrhea. Foot drop. Pruritus vulvae.

16. Signs Vulvar inspection: Ammonia smelling watery discharge per vaginam . Evidence of sodden and excoriation of the vulvar skin. Perineal tear Internal examination: The size, position, tissues margins are noted

17. Signs Speculum examination : Sim’s speculum is used and the patient is asked to be in sim’s position to view the anterior vaginal wall. The vagina becomes ballooned up in air because of negative suction. The bladder mucosa may be visibly prolapsed through a big fistula

18. Sim’s Position

19. Diagnosis Big Fistula: Tiny Fistula: Confusion in diagnosis: visible fistula tract Obvious escape of urine Dye test In knee-chest posistion escape of bubble of air when patient coughs Three- swab test Cystoscopy

20. Dye Test EUA is needed. The paitent is places in sim’s or knee chest position. A speculum is introduced and the anterior vaginal wall is swabbed dry. Methylene blue solution is introduced into the bladder by a catheter. If fistula is present the dye is seen coming out through the opening.

21. Dye Test

22. Metal Catheter Test A metal catheter is passed through the external urethral meatus into the bladder when come out through the fistula it confirm VVF.

23. Metal Catheter Test

24. Three-swab Test It is a diagnostic and differenting process for ureterovaginal and urethrovaginal fistula. Procedure: Three swabs are placed in the vagina 1. at vault. 2. at the middle. 3. just above the introitus . Methylene blue is introduced into the bladder via rubber catheter. The patient is asked to walk for about 5min. She then is asked to lie down and the swabs are removed.

25. Three-swab Test

26. Observation Inference The upper swab is soaked in urine and unstained with dye. The lower two fistula swabs remain dry. Upper and lower swabs remain dry but the middle is stained with dye. The upper two swabs remain dry and the lower on is stained with dye. Ureterovaginal fistula Vesicovaginal fistula Urethrovaginal Three-swab Test

27. Cystoscopy A cystoscopic examination with a small scope may be used to identify fistla in bladder and urethra. It particularly helps to clarify the exact anatomic origin.

28. 2. Urethrovaginal Fistula Cause: Small isolated UVF: 1. injury during anterior colporrhapy , urethroplasty . Symtoms : The patient has got urge to pass urine but the urine dribbles out into the vagina during micturition. Diagnosis: 1. When the metal catheter is passed through the external urethral meatus, it comes out through the communicating urethovaginal opening. 2. Three-swab test. 3. Cystoscopy.

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