Genital fistula

Genital fistula
    These r abnormal epithelialised communication tracts betn genital and urinary tract or elementary or both

C/f
 - presents with complaints of conastant dribbling of urine
 - constant wetness in genital area leads to excoriation of vagina, vulva
 - vvf at the bladder neck region following difficult child birth is common
 - woman of obstretic fistula is with short stature with contracted pelvis
 - positive methylene blue test confirms diagnosis

Investigation:
 - urine cuture
 - sonography
 - descending pylography
 - cystoscopy with idigocarmine excretion test
 - ureteric catheterisation
 - methylene blue 3 swap test

Management:
 - shuld be repaired vaginaly Latzko's procedure of denuding vaginal epithelium, freshning the edge and approximating wide raw surfaces
 - Chassar Moir technique: widely separating the vagina and bladder by the flap splitting method
 - if first attempt fails second is undertaken aft 3 months
 - for urinary divesion like implantation of ureters into sigmoid colon, creating an ileal loop bladder into which ureters r implanted, distal end of rectosigmoid is sutured and closed. Ureters implanted into rectal pouch
 - postoperative mx: continuous bladder drainage for 14 days
 - antibiotics
 - no vaginal or speculum exm or intercourese for 3 months aft surgery