OBSTETRIC FISTULA (Part Two)

Prevention

1. Reduce the risk through the reduction of the number of pregnancies by controlling them with family planning.
2. Through the reduction of pregnancy complications with antenatal care
3. Care in difficult vaginal deliveries and with cesarean section
4. Urinary catheterization

Diagnosis

1 - Medical history and physical examination

• Reports constant urinary leakage, 24 hours a day, regardless of activity.
• Onset of incontinence after childbirth or immediately after pelvic trauma.
• Direct observation of urine in the vagina.
• Observation and palpation of the defect in the anterior wall of the vagina or passage of urine from the cervical os.
• Vaginal examination with a speculum confirms vaginal leakage of urine.
• The location of the fistula, diameter, depth, mobility, and vaginal mucosa are assessed.
• Prolapse and urethral movement, insertion of a Foley catheter into the urinary bladder are assessed.
• We have the methylene blue test.
• We have the phenazopyridine hydrochloride test (orange urine). When the first test is negative and the second test is positive, we have ureterovaginal fistula.
• Sphincter function is assessed.
• Cystoscopy in the case of small fistulas.
• Ultrasound in the case of hydronephrosis.

2 - Laboratory tests

• The fluid is sent for creatinine analysis. An increase in its level in the fluid establishes the diagnosis for communication between the urinary bladder and vagina.
• For preoperative assessment in the blood, urea, creatinine, and electrolytes are evaluated.
• Complete urine, for the exclusion of urinary infections.
• Stool, parasite, for the exclusion of parasitic infections.
• Infectious analyses are performed for HIV, VDRL, Hepatitis B.

Classification of fistulas

1 - WHO System

• Good prognosis, in simple repairable fistulas, the surgeon repairs uncomplicated fistulas.
• Uncertain prognosis, in complicated fistulas that require referral and are repaired by a specialist surgeon.