[The clinical course and diagnosis of urogenital fistulae of obstetrico-gynecologic origin]

Abstract

Ninety two women with urogenital fistulas of obstetric-gynecological origin comprise the study group. In 23 patients (25 per cent) urine outflow from the vagina started immediately after the operation and in 69 (75 per cent) from the 3. day to 2.3 years after childbirth, obstetric operations and manipulations, gynecological and urogynecological operations, irradiation and nonsurgical gynecological diseases. Colpitis had 62 (68.9 per cent) of 90 women subjected to vaginal examination. Eighty patients (87 per cent) had clinical evidence of urinary tract infection and 92.2 per cent laboratory data. Predominated gram-negative bacterial causative agents. Impaired renal function including lack of function was demonstrated in 96.9 per cent of the patients with ureterovaginal fistulas, demonstrated by excretory urography, isotope nephrography and renal scintigraphy, whereas renal function in patients with vesicovaginal and urethrovaginal fistulas remained intact for a long time. In the authors' opinion, most important diagnostic methods are excretory urography, dye tests, cystoscopy with retrograde ureteral catheterization and ureteropyelography. Isotope methods of examination and renal echography are of major value for diagnosis of uretero-vaginal fistulas. Early in 1988 vaginography was included in the group of methods for diagnosis of urogenital fistulas.