Fistula

Question 1

Classification of fistulas

Answer 1

Simple <0.5cm
Complex: previously failed repair and or large-seize >2.5cm
Intermediate 0.5-2.5, but usually considered complex

Question 2

Etiology of VVF

Answer 2

Traumatic
Post surgical 
Any hysterectomy
Any incontinence surgery
POP repair
Vaginal biopsy
Bladder biopsy
Other pelvic surgery
External trauma
Radiation
Malignancy
Infectious/inflammatory
Foreign body
Obstetric
Obstructed labour
Forceps
Uterine rupture
Cs injury to bladder
Congenital

Question 3

Things to identify prior to surgery

Answer 3

Size
Number
Exact location

Question 4

Dye test

Answer 4

Fill bladder with dilute meth blue
Insert tampon into vagina
Tampon blue=fistula

Can also perform cystoscopy

Question 5

Percentage of spontaneous closure

Answer 5

10% close after 0.5 to 2 months of cathetrization and anticholinergic meds

Question 6

Contraindications to vaginal repair

Answer 6

Severely infuriated vaginal epithelium around the fistula
Small capacity or poorly compliant bladder
Repair requiring ureteric reimplantation
Involvement of other pelvic structures
Vaginal stenosis
Inability to obtain proper exposure

Question 7

Post op care

Answer 7

Catheter for 2-3 weeks
No sex for 3 months
Maintain dry uninflected suture line
Prolonged antibiotics (usually until catheter comes out)