Urinary fistulas - pathological message hollow of urinogenital bodies among themselves, with the intestinal lumen or with the body surface. Are more common in women than in men.
 Gallbladder-vaginal fistula (1) |
Urinary fistula women have gallbladder-vaginal (Fig.), mochetocnikov - vaginal, retro-gallbladder-vaginal, gallbladder-uterine and others, and caused injury, inflammation, tumors, as well as trophic disorders in the tissues of the urinary system. Urinary fistulas can be formed after a difficult delivery, rodorazreshajushchaja, gynecological or urological operations, due to the collapse of the tumor with intra-abdominal radiation therapy. There are urinary fistulas congenital, for example ectopia the mouth of the ureter, and acquired. Complaints with urinary fistula: full or partial incontinence in the absence or partially saved urination.
For urinary fistula characterized by maceration of the skin of the perineum and thighs, hyperemia and edema of the mucous membrane of the vagina. During examination of the vagina visible inverted scar or a fold of mucous membrane, which is allocated urine; sometimes you can define the hole urinary fistula, which is easy to spend pugovicy probe. For more accurate localization urinary fistula in entering the bladder 20 ml of 1% solution metilenovogo blue, and in the vagina is dry gauze tampon. When the gallbladder-vaginal fistula in 15 minutes put the swab is colored in blue.
Necessary examination in urinary fistula is chromatotherapy (see Cystoscopy), which helps to establish the location of the fistula, his attitude advanced close to the Ostia of the ureter and renal function. Lack of selection of Indigo Carmine from the mouth of the ureter when undetected fistula speaks in favor mochetocnikov-vaginal fistula.
The state of the upper urinary tract found out with the help excretory urography (see).
Treatment of urinary fistula. As a rule, dot retro-vaginal or gallbladder-vaginal fistulas are closed after electrocautery fistulous turn. Fistulas large diameter treated with surgery.
In the basis of the rehabilitation operations is the method of separation
mucous membranes urinary tract and genital organs with separate closure of fistulous holes. Operations are performed through the vagina or through the bladder. At large defects of the urinary bladder wall intestinal use plastic. If a large gallbladder-vaginal fistula close to impossible to produce colpocleisis, i.e. sutured outer hole vagina tightly.
When mochetocnikov-vaginal fistula ureter transplanted into a neat tip bladder - ureterosigmoidostomy. High location of the fistula, when it is not possible to tighten the bladder, producing operation of Bari: cut the flap of the bladder wall towards the ureter; formed from the flap tube sew with the ureter to the catheter.
Prevention of urinary fistula is in the correct management of labour and delivery operations (forceps delivery, perforation of the head of the fetus , and so on, and timely stitches when rupture of the vagina).
Care for patients with urinary fistula is a careful toilet vagina, douche solution of potassium permanganate (1 : 5000) or 3% solution of a dairy acid; in the gallbladder-vaginal fistula - irrigation of the bladder with solutions furatsilina 1:5000 or boric acid to 1 : 500. The chair should be a daily (to prescribe laxatives, enemas).
In the postoperative period it is necessary to monitor traffic diverting the urine catheter or drains, optionally cleaning them daily.
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