Gynaecological Fistulas

Max Brinsmead PhD FRANZCOG July 2012

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 3rd world countries it is obstructed labour and bladder necrosis In 1st 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 Wait until healed Then close from below or above 3-layered closure Bladder catheter or ureteric stent

For larger lesions:

Causes of Bowel Fistula

Obstetric injury

4th 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

Any Questions or Comments?

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