9. • Special tests:
1. Catheter test: comes out from vaginal
orifice of vagina.
2. Click test: metal catheter in bladder gives
click with metal probe passes through
vaginal orifice of fistula.
3. Methylene blue test:
4. Modified methylene blue test: no pads but
dye is observed directly…. Level & number.
5. Double dye test: after methylene blue test.
Diagnosis
15. Various surgical approaches
Vaginal Abdominal
Indications:
Simple, low ,easy accessible
Methods
•Flap splitting operation
•Sauccerization
•Latizko ( partial colpoclesis)
•Repair and graft
Indications:
Multiple ,large, complicated
,recurrent, related to ureter,
vault, associated with pelvic
pathology
Methods
Transperitoneal
,trans/intravesical with
graft
16.
17.
18.
19. Postoperative care
• Rest.
• Excess fluids.
• Drugs: antibiotics , urinary antiseptics,&
acidification of urine.
• Vaginal pack: 24h
• Urinary catheter: 10 days
– After removal of catheter: avoid bladder over
distention by voiding:
• Every 2h by day
• Every 4h by night
27. Diagnosis
• Symptoms:
• Large fistula: incontinence to flatus, liquid stool and
hard faeces.
• Small fistula: incontinence to flatus and liquid stool.
• Foul smelling vaginal discharge.
• Vulvitis &vaginitis.
• Signs:
• Inspection: Direct visualization
• Palpation: Digital palpation for fibrosis
• Investigations:
• MB Test
• Ba enema
• Proctosigmoidoscopy
28.
29. 1) RVF IN lower 1/3 of vagina
• Lawson Tait‘s operation
30. 2) RVF IN middle 1/3 of vagina
• Flap splitting as VVF.
• Start as rectocele repair and extend
dissection above the fistula.
3) RVF IN upper 1/3 of vagina
•Abdominal approche
Latzko operation
31. Postoperative care
• Early:
– Rest
– Diet
• Low residue diet
• Excess fluids
– local care:
• vaginal pack: 24h
• Antiseptics wash of the vulva after every micturition.
– Drugs
• Antibiotics, analgesics, laxatives
• Intestinal antiseptics
• Late : elective CS in subsequent delivery