40% heals spontaneously Uretero vaginal fistula most commonly follows trauma during pelvic surgeries like Total Abdominal Hysterectomy, Weheims hysterectomy and Vaginal hysterectomy. Symptoms Escape of urine through the vagina (True incontinence)deg Besides incontinence patient has also got the urge to pass urine and can pass urine normally.deg Patient may complain of : Flank pain Temperature Aetroperitoneal fluid collection (caused by urinary leak into the abdominal cavity due to transection of the ureter i.e. option 'a' is correct). Investigation : Three swab test differentiates it from VVF. lndigocarmine test : if the urine in the vagina is unstained following three swab test, indigocarmine is injected intravenously, if urine becomes blue diagnosis of uretero -- vaginal fistula is made. !VP : In case of ureteric transactions paial or complete, pyelography fails to show pa or whole of the ureter on the transected side and there may be pooling of dye in the peritoneal cavity. USG : Following ureter ligation, USG may reveal hydronephrosis and dilated ureter proximal to the site of block. CT scan. Management : One of the most controversial issues regarding the management of ureteral injuries diagnosed post operatively is the time of repair.. "The best chance of healing with primary repair is when reoperation is done within Me first 48 hours. Our opinion is that some form of immediate intervention must be undeaken no matter what the type of injury has occurred". "Uretero vaginal fistula should be repaired as early as possible to prevent upper urinary tract damage" When ureteral sweath is denuded for a sho segment, it is best to do nothing. When ureter is kinked due to a suture, it should be removed or deligated immediately. If clamped tissue is healthy and ble, splinting is done for 7-10 days for fuher, Ureteric transection : Ureteroneocystostomy (implantation of ureter into the bladder) when injury is near bladder. Uretero ureterostomy : end to end anastomosis : done when ureter is dissected above mid pelvis. Bladder flap operationdeg (MODIFIED BOARISdeg) : done when ureter is sho or injury is at the level of pelvic brim. Segment of small intestine may be used for repair. Ureteric transection : Ureteroneocystostomy (implantation of ureter into the bladder) when injury is near bladder. Uretero ureterostomy : end to end anastomosis : done when ureter is dissected above mid pelvis. Bladder flap operationdeg (MODIFIED BOARISdeg) : done when ureter is sho or injury is at the level of pelvic brim. Segment of small intestine may be used for repair.