Скачать или смотреть 86. Genital Fistula | OBG for USMLE Step 2 CK | Types, Causes, Diagnosis & Management

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Genital Fistula | OBG for USMLE Step 2 CK | Types, Causes, Diagnosis & Management

In this high-yield lecture, we cover genital fistulas, abnormal epithelial-lined connections between the genital tract and adjacent organs. Although relatively rare in high-resource settings, they are a significant cause of morbidity worldwide and a high-yield topic for USMLE Step 2 CK because of their obstetric, gynecologic, and surgical implications.

We begin with the types of genital fistulas:
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Vesicovaginal fistula (VVF): between bladder and vagina → continuous urinary leakage.

Urethrovaginal fistula: between urethra and vagina.

Rectovaginal fistula (RVF): between rectum and vagina → passage of flatus/feces per vagina.

Enterovaginal or uterovaginal fistulas: rare but clinically significant.

Etiology varies by setting:
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Obstetric causes: prolonged obstructed labor (common in resource-limited areas).

Iatrogenic causes: surgical trauma from hysterectomy or cesarean section.

Other causes: radiation therapy, malignancy, infections, or inflammatory bowel disease.

Clinical features include continuous urinary or fecal leakage, recurrent infections, excoriation, foul-smelling discharge, and social/psychological distress.

Diagnosis is made via:
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Clinical exam with speculum inspection.

Dye tests (methylene blue, charcoal) for urinary fistulas.

Endoscopy or imaging (cystoscopy, fistulography, MRI) for complex fistulas.

Management involves:
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Conservative measures: catheter drainage for small fresh fistulas.

Surgical repair: transvaginal or transabdominal approaches, with timing depending on tissue healing.

Supportive care: infection control, nutritional optimization, and psychosocial support.


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