Kamla, a 48 years old lady underwent hysterectomy on the seventh day. She developed fever burning micturition and continuous urinary dribbling. She can also pass urine voluntarily. The diagnosis is-
**Core Concept**
The patient's symptoms suggest a urinary tract complication following a surgical procedure, specifically a hysterectomy. The development of fever, burning micturition, and continuous urinary dribbling indicates a possible urinary tract infection (UTI) or a fistula formation. The ability to pass urine voluntarily alongside the dribbling suggests a communication between the urinary system and another organ or the skin.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with a vesicovaginal fistula (VVF), which is an abnormal connection between the bladder and the vagina. This condition can occur due to trauma, surgery, or radiation. The continuous dribbling of urine is caused by the loss of urine from the bladder through the fistula, while the ability to pass urine voluntarily suggests that the urethra and bladder are still intact. The development of fever and burning micturition indicates a UTI, likely caused by the fistula providing a conduit for bacterial entry.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not a likely diagnosis, as it does not explain the continuous urinary dribbling and the ability to pass urine voluntarily.
**Option B:** This option is incorrect, as it does not explain the specific symptoms of fever and burning micturition, which are characteristic of a UTI.
**Option C:** This option is not a likely diagnosis, as it does not explain the formation of a fistula or the continuous urinary dribbling.
**Clinical Pearl / High-Yield Fact**
A vesicovaginal fistula is a potentially preventable complication of pelvic surgery, and its diagnosis is often delayed due to the gradual onset of symptoms. A high index of suspicion and a thorough history and physical examination are essential for early detection and management.
**Correct Answer:** C.