Fistula Ug

8/11/2019 Fistula Ug

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UROGENITAL FISTULAS

Dr. St. Nur Asni, SpOG

Division of Urogynecology

Department of Obstetrics and Gynecology

School of Medicine, University of Hasanuddin


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DEFINISI

Urogenital Fistulas is an abnormalfistulous tract extending between thebladderand the vaginaor uterus thatallows the continuous involuntary

discharge of urineinto the vagina
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INSIDENS

Developing countries:

Most are due do totraumatic injury

USA: Ginecologicinjury


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ETIOLOGYI

Obstetric injury

Operative injury

gynecologic surgery Radiation therapy

Urologynecologic procedure

Non surgical causes : pelvic infection,bladder stone, pelvic trauma


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OBSTETRIC INJURY

when a prolonged labor presses theunborn child tightly against thepelvis, cutting off blood flow to thevesicovaginal wall. The affectedtissue may [[necrosis|necrotize]],leaving a hole.

Forceps delivery, cesarean section,


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Gynecologic surgery

Histerektomi transabdominal

Histerektomi transvaginal


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Classification


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Classification of vesicovaginal fistulasSimple

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 trigonalinvolvement


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Location of lower urinary tract structures

A. middle third

B. upper thirdC. of the vagina


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Diagnosis

Metilen Blue Test/ Intravesical dyetest

Vaginal tampon test

Flat tyre test Urograms

Cystourethroscopy

Hysterograms
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Management Small fistulas heal spontaneously Surgical principles for genitourinary fistula closure


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Operative

Futh Mayo procedure

Sims-Simon procedure

Latzko Colcopcleisis procedure Martius Bulbocovernosus Flap Plasty

procedure

Abdominal repair for complex fistula.


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Martius Flap


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Documents

Fistula Ug