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213 Gynaecology & Obstetrics

A 38-years old patient who had a total abdominal hysterectomy presents 2 months postop complaining of leakage of urine from the vagina. On examination, no fistula can be identified. Dilute methylene blue (100mL) is injected into the bladder through a Foley catheter and a tampon is placed in the vagina. The patient is asked to walk for about 15 minutes, after which the patient is found to be wet, but there is no blue stain anywhere on the tampon. Which of the following is true:-

A100mL was probably not enough methylene blue, and the test should be repeated with a higher volume
BThe patient probably has stress incontinence not a fistula
CThe patient probably has a ureterovaginal fistula
DThe patient most likely has small apical vesicovaginal fistula that was too small to leak the dye in 15 minutes
Gynaecology & Obstetrics
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