vesicovaginal fistula
Introduction
Introduction Bladder volume refers to the amount of urine in the bladder when there is urinary urgency and urgency. Under normal circumstances, the amount of urine discharged at one time is the bladder capacity. Residual urine refers to the amount of residual urine that cannot be discharged from the bladder after urination. When there is residual urine, the amount of urine discharged is not equal to the bladder capacity. At this time, the bladder capacity = the amount of urine discharged at one time. The normal bladder has a capacity of about 400 ml. When the bladder is inflamed, the bladder capacity is below 200 ml. The capacity of tuberculous bladder can be as small as 10 ml.
Cause
Cause
Bladder vaginal fistula is caused by high dystocia or caesarean section with cervical laceration involving the bladder. Patients with bladder spasm are more common, and they can communicate with the skin, intestines, and female reproductive organs. The primary disease is often a disease outside the urinary system. Common causes are: 1 primary intestinal disease - diverticulitis accounted for 50% to 60%; colon cancer 20% to 25%, Crohn's disease 10%; 2 primary gynecological disease - stress-induced necrosis caused by dystocia, Progressive cervical cancer; 3 after hysterectomy, low caesarean section or tumor radiotherapy; 4 injury. Malignant tumor necrosis of the colon, small intestine, vagina and cervix, severe bladder injury leading to the formation of abscess around the bladder, can be ulcerated to the perineum or abdominal cavity. In the gynecological vaginal surgery, the bladder may be accidentally injured. In addition, bladder incision and stone removal can also lead to the formation of a long-lasting fistula after prostate removal.
Examine
an examination
Related inspection
Intravenous urography, bladder ultrasound, vaginal urethral fistula, cystography, transvaginal ultrasound
Check the cervix often has a laceration or a defect in the anterior lip of the cervix. It is seen that the urine is flowing out of the neck tube and there is no pupil in the anterior wall of the vagina. If in doubt, it can also be confirmed by injecting a colored liquid from the urethra.
Use a probe to check the urethra for patency, and whether there is occlusion, stenosis or rupture, pay attention to the length of the remaining urethra. Oral pyridinium makes the urine orange-yellow. After one hour, put 3 cotton balls in the vagina, then inject methyl methylene blue into the bladder. The patient will check the cotton ball after a short walk. If the outermost cotton ball is wet dyed orange. That is, the ureterospasm is suggested. If the innermost cotton ball is dyed blue, it can be diagnosed as vaginal vagina. If only the outermost cotton ball is blue, the patient may be urinary incontinence.
Diagnosis
Differential diagnosis
Differential diagnosis of vesicovaginal fistula:
Partial urethral fistula or urethral defect: located in the urethra or below, the urethral sphincter is not damaged, the urination function can still be controlled, and the leakage of urine is not serious.
High bladder vaginal fistula or bladder cervix (or uterus): leaking urine when lying down, but no leakage when standing.
Ureteral vaginal leakage: It is characterized by leakage of urine, but at the same time, it can urinate on its own. Because one side of the ureter is damaged, urine flows into the vagina, and the other side of the normal ureter enters the bladder and is discharged through the urethra. However, if the ureterovaginal fistula is a bilateral ureteral injury, it completely loses the function of regular bladder urination, and only shows vaginal leakage.
One side of the ureteral fistula: before the communication with the vagina, it shows fever, bloating, ascites and so on. The patient can urinate on his own. When the sputum communicates with the vagina, the vaginal leaks urine and heat, and the ascites disappears.
Urinary fistula formed by bladder tuberculosis or vaginal tuberculosis: no history of dystocia or history of surgical injury. Bladder tuberculosis often has long-term symptoms of bladder infection, frequent urination, dysuria, pus and blood. The fistula caused by vaginal tuberculosis has no obvious prodromal symptoms. In both cases, there may be a history of tuberculosis or tuberculosis in other areas.
Urinary fistula formed by bladder stones: often has urinary pain, dysuria and history of hematuria. During the examination, you can even see stones that are exposed to the pupil or touch the stones in the bladder (via the pupil or through the urethra into the bladder through the urethra).
Tumor-induced: Most of them are advanced tumors, which are not difficult to identify from medical history and signs.
Check the cervix often has a laceration or a defect in the anterior lip of the cervix. It is seen that the urine is flowing out of the neck tube and there is no pupil in the anterior wall of the vagina. If in doubt, it can also be confirmed by injecting a colored liquid from the urethra.
Use a probe to check the urethra for patency, and whether there is occlusion, stenosis or rupture, pay attention to the length of the remaining urethra.
