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Gynaecological Fistulas

Gynaecological Fistulas. Max Brinsmead PhD FRANZCOG July 2012. Sites of Urine Leakage through the Vagina. Vesico vaginal fistula i.e. from bladder Uretero vaginal fistula i.e. from ureter Urethro vaginal fistula i.e. from urethra

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Gynaecological Fistulas

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  1. Gynaecological Fistulas Max Brinsmead PhD FRANZCOG July 2012

  2. Sites of Urine Leakage through the Vagina • Vesico vaginal fistula i.e. from bladder • Uretero vaginal fistula i.e. from ureter • Urethro vaginal fistula i.e. from urethra • Can be clinically distinguished with Methylene dye in the bladder and 3 swabs along the length of the vagina • Or • Cystoscopy and IVP

  3. Causes of Urinary Fistula • Obstetric injury • In 3rd world countries it is obstructed labour and bladder necrosis • In 1st world countries it is LSCS and unrecognised bladder or ureteric damage • Gynaecological injury • Hysterectomy – bladder or ureter • Incontinence repair – urethra • Malignancy • Bladder or cervix • Radiotherapy • Congenital • Trauma

  4. Management of Urinary Fistula • For small lesions: • Bladder catheter or ureteric stent • Wait for spontaneous closure • For larger lesions: • Wait until “healed” • Then close from below or above • 3-layered closure • Bladder catheter or ureteric stent

  5. Causes of Bowel Fistula • Obstetric injury • 4th degree tears • Gynaecological injury • Posterior repair • Malignancy • Rectum or cervix • Radiotherapy • Inflammatory Bowel Disease • e.g Crohns • Congenital

  6. Management of Faecal Fistula • May require a diversionary colostomy • Must treat the underlying problem when there is inflammatory disease or cancer • May also require anal sphincter repair

  7. Any Questions or Comments? For a copy of this PowerPoint go to www.brinsmead.net.au and follow the Link to “For Students”

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