Vesicovaginal fistula (VVF)
Vesicovaginal fistula (VVF)
Define Vesicovaginal fistula (VVF) : Abnormal communication between the bladder and the vagina and the urine escapes into the vagina causing true incontinence is called vesico- vaginal fistula.
We have described :
Management of Vesicovaginal fistula
Clinical feature of Vesicovaginal fistula
Investigation of Vesicovaginal fistula
Treatment of Vesicovaginal fistula
Symptoms of Vesicovaginal fistula (VVF) :
- Continuous escape of urine through vaginam is the classic symptom.
- NO urge to pass urine.
- Intermittent leakage of urine.
- Pruritus vulvae.
- On vulval inspection :
- Escape of watery discharge per vaginal of ammoniacal smell is characteristic.
- . Evidence of sodden and excoriation if the vulval skin.
- . Varying degrees of perineal tear may be present.
6. On internal examination : If the fistula is big enough its position, size and tissue at the margins are to be noted.
7. Onspeculum examination : The size, site and number of fistula
Investigation of Vesicovaginal fistula :
- EUA
- Three cotton swab test
- Dye test.
- Metallic catheter test.
Treatment of Vesicovaginal fistula :
Preventive :
- .Adequate antenatal care is to be extended to screen out at risk mothers likely to develop
- . Anticipation, early detection and ideal approach in the method of delivery in relieving the obstruction.
- . Continuous bladder drainage for a variable period of about 5-7 days following deliver either vaginal or abdominally in a case of long – standing obstructed labour.
- .Care to be taken to avoid injury to bladder during pelvic surgery obstetrical or gynaecological.
Immeddiate management : Once the diagnosis is made, continuous catheterization for 6-8weeks is maintained. THis may help spontaneous closure of the fistula tract.
Operative :
.Vaginal route :
- . Flap splitting method
- .Saucerization
- .Colpocleisis : Partial, Total
. Repair by graft :
- Vulval fat pad graft
- .Gracilis muscle graft.
- Omentum graft.
Abdominal route :
- Transvesical
- . Transperitoneal
- . Combined..
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