UROGENITAL FISTULAS

Dr. St. Nur Asni, SpOG

Division of Urogynecology
Department of Obstetrics and Gynecology
School of Medicine, University of Hasanuddin

DEFINISI
Urogenital Fistulas is an abnormal
fistulous tract extending between the
bladder and the vagina or uterus that
allows the continuous involuntary
discharge of urine into the vagina
INSIDENS

Developing countries:
Most are due do to
traumatic injury
USA: Ginecologic
injury

ETIOLOGYI
Obstetric injury
Operative injury
gynecologic surgery
Radiation therapy
Urologynecologic procedure
Non surgical causes : pelvic infection,
bladder stone, pelvic trauma

OBSTETRIC INJURY

when a prolonged labor presses the
unborn child tightly against the
pelvis, cutting off blood flow to the
vesicovaginal wall. The affected
tissue may [[necrosis|necrotize]],
leaving a hole.

Forceps delivery, cesarean section,




Gynecologic surgery
Histerektomi transabdominal
Histerektomi transvaginal


Classification

Classification of vesicovaginal fistulas
Simple
Fistula is less than 2 to 3 cm in size and near the cuff
(supratrigonal)
Patient has no history of radiation or malignancy
Vaginal length is normal

Complicated
Patient has had previous radiation therapy
Pelvic malignancy is present
Vaginal length is shortened
Fistula is greater than 3 cm in size
Fistula is distant from cuff or has trigonal
involvement

Location of lower urinary tract structures


A. middle third
B. upper third
C. of the vagina
Symptoms and signs
Uncontrollable and continuous leakage
of urine from the vagina
Small size leak only intermittenly
Ammoniacal odour of urine
Vulvovaginitis due to irritation
Diagnosis
Metilen Blue Test/ Intravesical dye
test
Vaginal tampon test
Flat tyre test
Urograms
Cystourethroscopy
Hysterograms



Management
Small fistulas heal spontaneously
Surgical principles for genitourinary fistula closure

Operative

Futh Mayo procedure
Sims-Simon procedure
Latzko Colcopcleisis procedure
Martius Bulbocovernosus Flap Plasty
procedure
Abdominal repair for complex fistula.

Martius Flap
Prophiylactic antibiotics
Avoid vaginal infection
Adequate urinary drainage suprapubic
bladder catheter
Postoperative intravenous urograms or cystogram
determine UT function and integrity of the
repair
Avoid sexual intercourse until 10 12 minggu.
Postoperative care