Kamla, a 48-years-old lady underwent a hysterectomy. On the seventh day, she developed fever, burning micturition and continuous urinary dribbling. She can also pass urine voluntarily. The diagnosis is:
Correct Answer: Uretero-vaginal fistula
Description: Continuous dribbling of urine following hysterectomy points towards urinary fistulas as the diagnosis.
In case of urinary fistulas, if the patient never needs to void as there is continuous dribbling it signifies that the fistula communicates with the bladder. If, there is filling and emptying of bladder along with the fistula, it suggests fistula opening into one ureter i.e. Ureterovaginal fistula.
As far as urethral fistula are concerned, they give little trouble because the urethra is normally empty of urine. However, during micturition urine passes through the fistula and may then fill the vagina to dribble during body movements for a short time afterwards.
This patient is developing symptoms on the seventh day can be explained by: "Fistulas resulting from accidental, surgical and obstetrical trauma are produced in two ways. They can be caused by a direct injury such as cuts and then they manifest themselves immediately by hematuria and incontinence. Alternatively, if they are the outcome of pressure necrosis or of ischemia, in such a case urinary incontinence, fever and burning micturition develop 7-14 days after the accident."
Before concluding let's rule out other options as well:
In stress incontinence, dribbling of urine occurs only when intraabdominal pressure is raised.
In urge incontinence, the patient has the urge to void urine at a moment's notice and she is unable to control her bladder and passes urine instantly.
Category:
Gynaecology & Obstetrics
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