Most impoant manifestation of ureterovaginal fistula is: September 2009
**Core Concept**
A ureterovaginal fistula is an abnormal connection between the ureter and the vagina, leading to the leakage of urine into the vagina. This condition often results from surgical complications, trauma, or pelvic radiation, causing significant morbidity and quality of life impairment for affected women.
**Why the Correct Answer is Right**
The most common and clinically significant manifestation of ureterovaginal fistula is **urine leakage into the vagina**, which can be continuous or intermittent. This leakage can cause a range of symptoms, including a constant dribble of urine, dysuria, and vaginal discharge. The presence of a ureterovaginal fistula can also lead to chronic pelvic pain, pelvic abscesses, and recurrent urinary tract infections.
**Why Each Wrong Option is Incorrect**
* **Option A:** While urinary incontinence is a symptom of ureterovaginal fistula, it is not the most important manifestation. Urinary incontinence can be managed with conservative measures, but the presence of a fistula requires surgical intervention.
* **Option B:** Vaginal discharge can be a symptom of ureterovaginal fistula, but it is not the most important manifestation. Vaginal discharge can be caused by a variety of conditions, and the presence of a fistula must be confirmed with imaging studies or cystoscopy.
* **Option C:** Chronic pelvic pain is a possible complication of ureterovaginal fistula, but it is not the most important manifestation. Chronic pelvic pain can be caused by a variety of conditions, and its presence does not necessarily confirm the diagnosis of a fistula.
**Clinical Pearl / High-Yield Fact**
The presence of a ureterovaginal fistula can be confirmed with imaging studies, such as intravenous pyelography (IVP) or computed tomography (CT) scans, which can show the abnormal connection between the ureter and the vagina. Cystoscopy is also a valuable diagnostic tool, allowing the visualization of the fistula and the assessment of the ureteral and bladder mucosa.
**Correct Answer: B. Vaginal discharge.**