Medicine an Surgery notes

Apr 24th, 2015
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VESICOVAGINAL FISTULAAbnormal communication between the vagina and the bladderIncidence2 million women2-5/1000 deliveries3000 new cases annuallyCauseProlonged or obstructed labour (obstructed fistula) - 90%Surgery - colporrhaphy (Repair of a rupture of the vagina by excision and suturing of the edges of the tear), cesarean section, total abdominal hysterectomyRadiation cystitis secondary to radiation treatment for carcinoma of the cervixInvasive cancer of the cervix, vagina leading to tumor invasion of the vesicovaginal septum.Trauma - gynecologic trauma, pelvic fractures, rape, abortion, FGMInfections - schistosomiasis, measles, TBCongenital - ectopic ureters or vesicle (defects of the anterior abdominal wall), epispadiasPrimitive obstetric practices - forceps, vacuum with vaginal wall inclusionEtiogenesisObstructed labor results from a large baby (CPD) or breech. There is compression of soft tissue between the fetal head and pelvic bones and within 3hrs, tissue necrosis occurs with fistula formation;VVF - 80%RVF - 10-15% (combined with VVF)CommunicationsBladder - vagina - Vesicovaginal fistulaBladder - Cervix and vagina - Vesicocervicalvaginal fistulaBladder - Uterus - Vesicouterocervicovaginal fistulaUreter - vagina - Ureterovaginal/Ureteric fistulaS/SConstant urinary incontinence is the cardinal symptom. Urine can usually be seen coming through an opening in the vagina.; the vaginal ostium is at or near the vault closureWetness and foul smel

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