urethral fistula
Introduction
Introduction Urinary fistula refers to the abnormal passage formed between the reproductive organs and the urinary system, which is characterized by leakage of urine. Common vaginal fistula, urethra vagina, ureterovaginal fistula (collectively called urinary fistula). The genital fistula is an extremely painful injury. According to the urine flow, it is divided into external hemorrhoids and internal hemorrhoids. The external hemorrhoid is that the urine is partially or completely excreted through the abnormal passage of the urethra during urination, such as the genital tract of the penis, the scrotum, and the perineum. Internal hemorrhoids are urine that partially or completely flow through another organ in the body and then excreted, such as urethra vagina and urethral rectal fistula.
Cause
Cause
The causes of congenital urethral fistula are:
After the fifth week of the development of the first child, the urinary genital folds cannot separate the rectum from the urogenital tract, and the urethra is connected with the rectum (male) or the vagina (female), thereby causing urethral rectal fistula (male) or urethra vagina (female). ). The former is often accompanied by congenital distal rectal atresia.
2 hypospadias.
3 Repeat the urethra.
The causes of acquired urethral fistula are:
1 urinary tract injury, such as war wounds, car accidents, urethral injuries at work accidents, especially the posterior urethral injury associated with pelvic fractures, and the urinary tract ball.
2 pelvic, vaginal anterior or urethral surgery, instrument operation and intraurethral stones, foreign body injury caused by foreign bodies.
3 defects in the urethra or vaginal anterior wall caused by childbirth or dystocia.
4 urethra or anterior wall of the vagina, malignant tumor of the cervix and radiotherapy.
5 urethral tuberculosis, gonorrhea, periurethal abscess, perineal abscess, urethral diverticulum, urethral gland infection, etc. directly collapse, or urethral stricture, urinary obstruction and secondary infection to the urethra.
6 penile line or metal ring caused local tissue necrosis.
7 Long-term indwelling catheterization is improperly placed, or the catheter is pulled down to the lower extremity, and the urethra at the junction of the penis and scrotum is oppressed to cause necrosis and secondary infection.
Examine
an examination
Related inspection
Urethral function test vaginal urethral fistula urinary fistula detection
1. Leakage of urine: The urine flows out of the vagina from time to time.
2. Infection of the vulva, buttocks, inner thigh skin: due to long-term immersion by urine, different degrees of dermatitis, rash and eczema occur, causing local itching and burning. If it is smashed, it can cause secondary infection and bloated. Patients with urethral fistula sometimes have varying degrees of urinary tract infection symptoms. If the ureterospasm is accompanied by local ureteral stricture, the renal pelvis expands and accumulates water, which is more likely to cause infection. Some form a retroperitoneal urinary extravasation, and then infection, and then vaginal leakage, occasionally after radical resection of cervical cancer.
3. Amenorrhea: may be due to trauma, about 10% to 15% of patients with urethral fistula may have secondary amenorrhea or rare menstruation.
4. Mental pain: Because the urine does not divide into the day and night, the season, constantly discharged from the vagina, wet clothes, bedding, can not sleep at night, inconvenient or unwilling to go out to participate in social activities during the day, affecting learning and production labor; Some people with leaking urine have vaginal scar stenosis or partial atresia, loss of sexual life and fertility, affecting couples' feelings and family relationships. All of these kinds of patients bring great mental pain to the patients, resulting in mental depression, secondary amenorrhea. .
5. Gynecological examination
(1) Do not urinate patients before sputum, and then urinate after observation to help find small pupils.
(2) The larger the pupil, the bright red bladder mucosa that is turned out from the pupil. If the pupil is small or the part is high and it is not easy to see, the patient may cough or take a deep breath. It is often seen that urine and air bubbles overflow from the pupil; or the uterus probe is inserted into the urethra, and a finger is inserted into the vagina. Move, when the probe reaches the pupil, the two may meet, or the probe enters the vagina through the pupil, or the colored liquid is injected into the urethra, and the leak is observed, and further confirmed by the probe.
(3) Bladder cervix vaginal fistula due to high dystocia or caesarean section with cervical laceration involving the bladder. Check the cervix often has a laceration or a defect in the anterior lip of the cervix. It is seen that the urine is flowing out of the neck tube and there is no pupil in the anterior wall of the vagina. If in doubt, it can also be confirmed by injecting a colored liquid from the urethra.
(4) If the urethra of the bladder is vaginal fistula, use a probe to check whether the urethra is unobstructed, and whether there is occlusion, stenosis or rupture, and pay attention to the length of the remaining urethra.
Diagnosis
Differential diagnosis
Differential diagnosis
1. The ectopic ureteral orifice is congenital development abnormality, and there are many renal pelvis and double ureteral malformations. In addition to urinating in the normal urethra, it can continue to leak urine in the urethra, perineum, vagina, uterus, cervix, vagina, vestibule and other parts. In the excretory urography, repeated renal pelvis and repeated ureter, often with upper hydronephrosis. After intravenous injection of rouge, blue dyed urine can be continuously drained at the ectopic ureteral orifice.
2 Bladder vaginal fistula: continuous discharge of urine from the vagina. After injecting the methylene blue solution into the bladder, the vaginal gauze is blue-stained and does not have to wait until after urination. Cystoscopy revealed a fistula in the bladder.
3. Ureteral vaginal fistula: caused by pelvic or intravaginal surgical injury. There is a continuous drip of urine in the vagina. After the gauze is inserted into the vagina, the bladder is filled with a methylene blue solution, urinating or not urinating, and no gauze blue dyeing. Excretory urography or retrograde urography, ureteral contrast agent spillover, ureteral dilatation above the level. When the retrograde ureter is intubated, it is blocked in the middle and lower segments of the ureter.
