Urinary fistula

Introduction Urinary fistula refers to the abnormal passage formed between the reproductive organs and the urinary system, which is characterized by leakage of urine. Common vaginal fistula, urethra vagina, ureterovaginal fistula (collectively called urinary fistula). The genital fistula is an extremely painful injury. Because the urine can not be controlled by itself, the genital area is soaked in the urine for a long time, which not only brings physical pain to the woman, but also the patient can not participate in the production labor because of fear of being close to the masses, and the mental burden is also great. Strengthening the health care of pregnant women, carrying out new births, correctly handling childbirth, improving the quality of surgery, and genital damage can be avoided. The occurrence of genital fistulas will inevitably be greatly reduced.

Cause

First, birth injury

(1) Delayed production: due to the lack of head basin, fetal position abnormality, fetal abnormality, congenital vaginal malformation or vaginal scar, etc., the fetal exposed part is blocked in the small pelvic cavity, causing delayed labor, especially the second stage of labor to prolong the formation of urinary fistula ,most influential.

(B) obstetric surgery injury: rough operation in obstetric surgery, the instruments used (pliers, craniotomy, fetal head aspirator) directly damage the vaginal wall, bladder and urethra. Uterine rupture complicated by bladder or ureteral injury or cesarean section incision tear prolonged damage to bladder tissue, or sutured ureter or sutured the bladder wall, negligent during surgery, did not treat to form urinary fistula.

Second, gynecological surgery injury: whether it is pelvic gynecological surgery through the abdomen or transvaginal, such as lack of responsibility, the operation is not meticulous, unfamiliar with the anatomy, technically unskilled, or blind bleeding during surgery, especially pelvic inflammatory adhesions , or genital tumors (uterus, ovary or broad ligament tumors), uterine prolapse, etc., anatomical relationship of the pelvic adjacent organs, if the injury is not found, or found to repair poorly, then the formation of vesicovaginal fistula or ureter Vaginal fistula and so on.

an examination

First, the medical history: First, you should carefully ask the medical history to determine the cause of urinary fistula. If it is a tuberculosis lesion, it is necessary to treat it first.

Second, check: check the patient's urination before checking the pupil, and then urinate after observation, to help find small pupils. In order to facilitate the exposure of the pupil during the examination, the patient can take the knee and chest position, take a single-leaf vaginal hook or use the lower vaginal vaginal appress, and lift the posterior vaginal wall. Thus, common common pupils, such as vaginal vagina, urethra Vaginal fistula, bladder urethra, vaginal fistula, etc., together with all the anterior vaginal wall and cervix can be seen under the speculum. The size, location, nature of the fistula, the presence or absence of scar tissue around the pupil, and the urethra and urethral sphincter conditions must be examined in detail. For those with large pupils or near the triangle of the bladder, it is also necessary to pay attention to the distance between the ureteral orifice and the edge of the pupil (in the case of a large vesicovaginal fistula, urinary tract urinary tract is sometimes seen) and the presence or absence of inflammation, scarring and stenosis in the vagina.

Differential diagnosis

Urinary fistula symptoms need to be differentiated from the following symptoms.

1. Stress urinary incontinence: The main lesion may be in the urethra, urethral sphincter or pelvic floor muscle relaxation, short urethra or posterior urethra of the bladder. Therefore, when the abdominal pressure increases, the intravesical pressure is higher than the pressure in the urethra. To.

2. Bladder contracture: Because of tuberculosis, bladder fibrosis becomes hard and inelastic, the volume is very small, the number of urination is high, and the bladder neck loses contraction due to contracture, resulting in uncontrollable urine and continuous spillover. Symptoms are similar to urinary incontinence. . Some are due to the loss of urinary function caused by sphincter invading the bladder neck tuberculosis. These patients have typical symptoms of bladder irritation, hematuria and tuberculosis. Cystoscopy, urography, and urine culture can be further confirmed. Sometimes tuberculous contracture bladder can also be combined with urinary fistula.

3. Neurogenic bladder dysfunction: urinary dysfunction caused by damage to the central or peripheral nerves that regulate bladder function. More common in spinal cord diseases, such as inflammation, tumors and recessive spina bifida; occasionally seen in bladder nerve injury after extensive radical resection of cervical cancer; also seen in bladder palsy after prolonged fetal head pressure. The clinical manifestation is that the detrusor contraction is weak and causes urinary retention. When the bladder is overfilled, part of the urine involuntarily overflows through the urethral opening.

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