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Prolapse, Urogynecology & Infections

Question
29 out of 30
 

Most useful investigation for VVF is (AIPG 2010)



A 3 swab test
B Cystoscopy

C Urine culture
D IVP

Ans. B
Cystoscopy

1. Genito-Urinary Fistulae

a. An abnormal communication between the urinary and genital tract either acquired or congenital with involuntary escape of urine into the vagina.

b. Incidence in referral hospitals as high as 05 to 3 % earlier on now reduced.

c. Types +Bladder

- Vesico –vaginal - Vesico- urethro-vaginal

- Vesico-uterine - Vesico-cervical

+ Urethra - Urethro-vaginal

+ Ureter - Uretero-vaginal

- Uretero-uterine - Uretero-cervical

VVF commonest

2. Causes

a. A. Obstetrical commoner in developing countries 80-90 % as compared to 5-15 % in developed countries.

b. Causes Ischaemic takes 3-5 days after obstructed and prolonged

c. Delivery

Traumatic Instrumental like with forceps

During LSCS

d. Gynaecological 80 % in developed countries

Operative

Traumatic

Malignancy

Radiation (takes upto 1-2 years after RT)

Infective chronic granulomatous lesions like TB / LGV /

/ Schistosomiasis / actinomycosis

3. Presentation

a. A continuous dribbling of urine with sodden and excoriated vulval skin

b. Confirmation of diagnosis

Speculum examination

EUA

Dye test using Methylene blue

Three swab test

Indigo carnine test (given IV) to pick up an ureterine fistula

Cysto-urethroscopy

4. Treatment

a. Preventive: Ante-natal care

Intrapartum care

Prophylactic catheterization in case of doubt

b. Operative: best time 3-6 months after injury so that the general condition improves and the local tissue are likely to be free from infection. Further delay will lead to an increase in fibrosis.

c. American view point Most obstetric fistulas can be operated upon immediately however postsurgical cases are repaired after 3-6 months.

d. Prolonged and obstructed labor is the MC cause of VVF in India.

e. History & clinical examination are very important.

f. Urine routine & culture should be done to rule out concomitant infection.

g. If ureter involvement is suspected then IVP can be performed.

h. Dye test can be done. Methylene blue dye is inserted in bladder & vaginal examination is done. Appearance of blue dye in vagina indicates a VVF.

i. The most useful investigation is cystoscopy. All patients should undergo cystourethroscopy prior to surgery. It helps to find exact location (in relation to ureteral orifices), size & number of fistulae.

j. 3 swab test is done to differentiate between VVF, ureterovaginal & urethrovaginal fistula.

Prolapse, Urogynecology & Infections Flashcard List

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