NEW APPROACH TO FISTULA

PRESENT BY Dr. Ali Gaffer Mohammad Consultant Obs.&Gyn.& URO-gynecologist Dr.ABBOs Fistula & Uro-Gynaecological Center
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FISTULA FISTULA : Is communication between two organs which covered by epithelium .

URO-INTESTINOGENITAL FISTULA

Uro Intestino- genital fistula : - Is a communication between urinary and genital tract , Intestin and genital tract .

Uro-Intestino- genital fistula is divided into three main groups

I\ URO-GENITAL FISTULA II\ INTESTINO-GENITAL FISTULA III\URO-INTESTINO-GENITAL FISTULA(COMPOUND)

URO-GENITAL FISTULA(UGF) may be :1. 2. 3. 4. VESICO-VAGINAL FISTULA(VVF) VESICO-UTERINE FISTULA (VUtF) VESICO-CERVICAL FISTULA(VCF) VESICO-URETHRO-VAGINAL FISTULA(VUVF) URETHRO-VAGINAL FISTULA(UVF) URETERO-VAGINAL FISTULA(UrVF) URETERO-UTERINE FISTULA(UrUtF) URETERO-CERVICAL FISTULA (UrCF)
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5. 6. 7. 8.

INTESTINO GENITAL FISTULA (IGF)

1. 2. 3. MAY be :RECTO-VAGINAL FISTULA(RVF) INTESTINO- VAGINA FISTULA(IVF) INTESTINO- UTERINE FISTULA(IUtF) 4. COLOACA FISTULA (CAF) 6 ) (VAGINAL TRACT FISTULAVTF

UR0-INTESTINO-GENITAL FISTULA(UIGF) COMPOUND

1. 2. 3. 4. INTESTINO-VESICAL FISTULA(IVF) VVF+RVF VVF+UrVF VUVF

CAUSES OF FISTULAE
I\ CONGNITAL

1. URETHRAL (patulous urethra) 2. URETRAL (ectopic ureter) 3. Bladder ( ectopea vesicae)

II\ VASCULAR
1. ISCHEMIC (URETER LIAGATION) 2. NECROTIC (OBST. LABOUR)

III\ DISEASES
A\ 1. 2. 3. BENIGN T.B. BILHARZEASES INFLAMTION ( ULCER)

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B\ MALIGNAT
1. 2. 3. 4. 5. BLADDER TUMORS UTERINE TUMORS CERVICAL TUMORS COLON TUMORS PELVIOABDOMINAL TUMORS
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IV\ TRUMATIC
A\ DIRECT TRUMA 1. MEDICAL INTERVENTION -C\S -TAH -REPAIR -LAPROTOMY -FORCEPS 2. LACERATION (extended cx. tear) 3.Accedental - Road traffic accident - Gun shot
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B\ INDIRECT TRUMA
FORIGN BODY VESICAL STONE LOOP SLING

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V\ MANEGMENT

RADIATION(RADIOTHERAPY)

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Predisposing Factors
LACK OF MEDICAL SERVECES &PERSONNEL LACK OF ROADS EARLY MERRAGE ILLTRACY POVERTY
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DIAGNOSIS -EXAMINATION
1. 2. 3. 4. PV SPECULUM AND METALIC CATHETER PROB AND METALIC CATHETER DYE TEST (gentian violet, methylen blue)

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INVESTIGATION
CYSTOSCOPY IVU( uretero-vaginal fistula) RETROGRAD CYSTOPYILOGRAPHY KUB (vesicle stone)

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Divided to Four groups(4RS) I\REPAIR 1. SIMPLE REPAIR( SPILITING TECH.) 2. REPIR WITH GRAFT LIBAL FAT GRAFT (LFG) BULBO-SPONGEOUSES MUSCLE VAGINAL(VAGINAL CYSTOPLASTE\) OMENTUM

MANAGEMENT

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II\REINMPLANTION (diversion)
URETERAL URETERO-SIGMOID ILIOCODIOUT

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III\ REFORMATION
COLPOCLEASES CREATION OF NEW BLADDER (METROFANOF OPERATION)

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IV\ RECONSTRUCTION
URETHRAL RECONSTRUCTION URETRAL TUNLLING

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