1. Obstetrics fistula
Genito-urinary fistula is an abnormal communication between the
urinary system (ureters, bladder, and urethra) and the genital syestem
(uterus, cervix, and vagina) systems.
Global estimate is about 100,000 new cases per year.
Its common cause (90%) in developing countries is obstructed labor.
Ethiopia 97 % obstetric cause.
One study showed 83.6% of cases of fistula occurred before age of
54-60 % of them were divorced
Method of classification is
based on anatomic position
of the communication.
Fistulas can develop at any
point between the genital and
is the most common among
Female genital mutilation
Obstructed labour :the most common.
Traumatic Forceps delivery
Rupture of the uterus
Pelvic Surgery (hysterectomy ,c/s )
Compression between presenting part and posterior surface of the
pubis that leads to ischemic necrosis of the bladder neck and anterior
Sometimes the anterior lip of cervix and trigone could be injured
If the compression of soft tissues occurs posteriorly between sacral
promontry and presenting part necrosis of posterior vaginal wall and
underlying rectum occurs
Injured areas slough between third and tenth day of puerperium
5. Clinical feature of VVF
Continuous urine leakage vaginally occur in the 3-10 days of
Have foul ammoniac odor.
Low self esteem
Disrupted sexual relationship
1. leakage of excessive volume of fluid per vagina with no voided
2. Small amount of urine leakage via vagina but has regular voiding
(Ureterovaginal fistula )
3. Leakage during and after voiding via vagina(Urethrovaginal
Although direct observation is mainstay of diagnosis , Pinpoint
fistulas can be difficult to locate.
Bladder instillation of visually distinct solutions such as methylene
blue, sterile milk, or indigo carmine can often indicate the location.
When the presence of a urinary fistula is uncertain or the location in the
vagina cannot be identified, a modified tampon test or three-swab test
After the patient has engaged in 15 to 30 minutes of routine activity, the
gauze is removed serially from the vagina and inspected for presence of
The specific gauze colored with dye suggests where in the vagina a
fistulous tract is located—a proximal or high location in the vagina for
the innermost gauze, and a low or distal fistula for the outer most ended
It allows localization of the
fistula, determination of its
proximity to the urethral
orifices, and assessment of
surrounding bladder mucosa
Schedule After three months for healing of
necrotized tissues around the hole
Treat any infection or inflammation.
Correct nutritional status.
Perineal skin care
It is mainstay of treatment, vg approach.
Notes de l'éditeur
In UK and USA 70-95 % is due to gynecologic surgery
In this study mean age at marriage and delivery is 14.7 and 17.8yrs respectively.
Although the ideal method of confirming genitourinary fistula is by direct visualization, there are inst ances in which physical examination and inspection are unrevealing.