L4: Genital Fistula

Question 1

What is a Fistula?

Answer 1

• in anatomy is an abnormal connection () 2 hollow spaces (technically, 2 epithelized surfaces), such as blood vessels, intestines, or other hollow organs as vagina, rectum, ureter, …… etc.
• Types of fistulas can be described by their location.

Question 2

Def of Genital Fistula

Answer 2

• Abnormal communications () the genital tract [vagina, cervix, uterus, fallopian tube] and other hollow organs or cavities [urinary bladder, ureter, rectum, intestine, skin].
• Of all fistulas 2 fistulas are of concern to the gynecologist: vesicovaginal (VVF) & rectovaginal (RVE),|

Question 3

Def of Urogenital Fistula

Answer 3

• Abnormal communications urine passes from the urinary system to the genital system i.e from bladder to vagina, from ureter to vagina, … and so on.
• The name of the fistula follows the direction of urine e.g. vesico-vagina, uretro-vaginal, …… and so on.

Question 4

Types of Urogenital Fistula

Answer 4

Question 5

Def of Vesico-Vaginal Fistula

Answer 5

Question 6

Etiology of Vesico-Vaginal Fistula

Answer 6

Question 7

Etiology of Vesico-Vaginal Fistula

• Congenital

Answer 7

• Rare
• Usually associated with other urogenital malformations

Question 8

Etiology of Vesico-Vaginal Fistula

• Obstetric

Answer 8

The most common type (90%) in developing countries due to:
- Bad conduct of labor;
- Prolonged fetal head impaction (ischemia), or
- Traumatic (forceps, ventouse, others).

Question 9

Etiology of Vesico-Vaginal Fistula

• Surgical

Answer 9

The most common type of VVF in developed countries occur during:

• Pelvic surgeries (gynecological, urological, or oncologic surgeries).

Question 10

Etiology of Vesico-Vaginal Fistula

• Radiation

Answer 10

Following pelvic irradiation, e.g cancer cervix, rectal cancer

Question 11

Etiology of Vesico-Vaginal Fistula

• Malignant

Answer 11

Due to bladder invasion of nearby malignancy, e.g. cancer cervix, rectal cancer.

Question 12

Etiology of Vesico-Vaginal Fistula

• Others

Answer 12

• Neglected vaginal pessary.
• Neglected foreign body.
• Trauma after falling astride on sharp objects.

Question 13

Types of Vesico-Vaginal Fistula

Answer 13

Question 14

Types of Vesico-Vaginal Fistula

• Acc to simplicity

Answer 14

Question 15

Types of Vesico-Vaginal Fistula

• Depending upon Site of The Fistula

Answer 15

Question 16

Symptoms of Vesico-Vaginal Fistula

Answer 16

Question 17

Dx of Vesico-Vaginal Fistula

Answer 17

Question 18

Dx of Vesico-Vaginal Fistula

• Hx

Answer 18

Question 19

Dx of Vesico-Vaginal Fistula

• Ex

Answer 19

Question 20

Dx of Vesico-Vaginal Fistula

• INVx

Answer 20

Question 21

Management of Vesico-Vaginal Fistula

Answer 21

Question 22

Management of Vesico-Vaginal Fistula

• Prophylaxis

Answer 22

Question 23

Prophylaxis for VVF

• Obstetric VVF

Answer 23

Question 24

Prophylaxis for VVF

• Surgical VVF

Answer 24

Question 25

Management of VVF

• Consrvative

Answer 25

Question 26

Management of VVF

• Surgical

Answer 26

Question 27

Surgical Managment of VVF

• Timing

Answer 27

Question 28

Surgical Managment of VVF

• Surgical Approaches

Answer 28