Materiały źródłowe

• #1 Vaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/diagnosis-treatment/drc-20563198

  Your healthcare professional has many ways to find out if a vaginal fistula is the cause of your symptoms. You’ll be asked questions about your medical history. You’ll get a physical exam, which may include a pelvic exam. You also may need other tests. […] During the physical exam, your healthcare professional checks the outside of your vagina, anus and the area between the two, called the perineum. Your healthcare professional looks for symptoms such as scarring, irregular vaginal discharge, leaking urine or stool, and pockets of pus called abscesses. […] A pelvic exam also may be done to check the health of your outer vagina and your reproductive organs. During the exam, your healthcare professional inserts one or two lubricated, gloved fingers into your vagina with one hand. At the same time, the other hand presses gently on the outside of your lower stomach. A device called a speculum may be used to spread open the walls of your vagina and see inside it.

• #1 Vaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/diagnosis-treatment/drc-20563198

  If a vaginal fistula isn’t found during a physical exam, you may need other tests. These could include the following: […] Dye test. In this test, your healthcare professional fills your bladder with a dye solution and asks you to cough or bear down. If you have a vaginal fistula, dye appears in your vagina. You also may see traces of the dye on a tampon after physical exercise. […] Cystoscopy. During this exam, your healthcare professional uses a hollow device equipped with a lens. The device is called a cystoscope. With the cystoscope, your healthcare professional can see inside your bladder. The inside of the small tube that carries urine outside the body, called the urethra, also can be seen. This lets your healthcare professional check for any problems. […] Retrograde pyelogram. In this test, your healthcare professional injects a substance into your bladder and the tubes that connect the bladder to the kidneys, called the ureters. Then an X-ray is taken. The X-ray image can show your healthcare professional if there’s an opening between a ureter and the vagina.

• #1 Vesicovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/267943-workup

  Upon examination of the vaginal vault, any fluid collection noted can be tested for urea, creatinine, or potassium concentration to determine the likelihood of a diagnosis of VVF as opposed to a possible diagnosis of vaginitis. […] Indigo carmine dye can be given intravenously and if the dye appears in the vagina, a fistula is confirmed. […] Once the diagnosis of urine discharge is made, the physician must identify its source. Cystourethroscopy may be performed, and the fistula(s) may be identified. […] A full vaginal inspection is essential and should include assessment of tissue mobility; accessibility of the fistula to vaginal repair; determination of the degree of tissue inflammation, edema, and infection; and possible association of a rectovaginal fistula. […] Urine should be collected for culture and sensitivity, and patients with positive results should be treated prior to surgery.

• #1 Vaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/diagnosis-treatment/drc-20563198

  Fistulogram. A fistulogram is an X-ray image of the fistula. This test may help your healthcare professional see if you have more than one fistula. Your healthcare professional also may be able to see what other pelvic organs may be affected by a fistula. […] Flexible sigmoidoscopy. During this test, your healthcare professional uses a thin, flexible tube with a tiny video camera at the end. This device is called a sigmoidoscope. It lets your healthcare professional check the anus and rectum. […] Computerized tomography (CT) urogram. In this test, you have a contrast material injected into a vein. Then your healthcare professional uses a CT scan to make images of the vagina and urinary tract. […] Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to make detailed images of organs and tissues in the body. With a pelvic MRI, your healthcare professional can see the path of a fistula between the vagina and rectum.

• #1 Vaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/diagnosis-treatment/drc-20563198

  If imaging tests find a vaginal fistula, your healthcare professional may remove a small sample of tissue. This is called a biopsy. A lab checks the biopsy sample for signs of cancer. It’s not common, but some vaginal fistulas can be due to cancer. […] You also may need lab tests to help find the cause of your symptoms. These could include tests of your blood and urine.

• #1 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  To diagnose a rectovaginal fistula, your health care provider will likely talk to you about your symptoms and do a physical exam. Your provider may suggest certain tests depending on your needs. […] Most commonly, a rectovaginal fistula is easily seen during a pelvic exam. If a fistula is not found during the exam, you may need tests. These tests can help your medical team find and look at a rectovaginal fistula and can help plan for surgery, if needed. […] A CT scan of your abdomen and pelvis gives more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause. […] This test creates images of soft tissues in your body. MRI can show the location of a fistula, whether other pelvic organs are involved or whether you have a tumor. […] If other testing does not find a fistula, your surgeon may need to examine you in the operating room. This allows for a thorough look into the anus and rectum and can help locate the fistula and help plan surgery.

• #1 Vesicovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/267943-workup

  In patients with a history of local malignancy, a biopsy of the fistula tract and microscopic evaluation of the urine is warranted. […] Radiologic studies should be employed prior to surgical repair of a VVF. An intravenous urogram (IVU) is necessary to exclude ureteral injury or fistula because 10% of VVFs have associated ureteral fistulas. […] If suspicion is high for a ureteral injury or fistula and the IVU findings are negative, retrograde ureteropyelography should be performed at the time of cystoscopy and examination under anesthesia. […] Intraoperative assessment for bladder or ureteral injury may be performed by administering indigo carmine intravenously and closely observing for any subsequent extravasation of dye into the pelvis. […] A cystoscopic examination with a small scope (eg, 19F) may be used to identify VVF in the bladder or urethra, to determine the number and location and proximity to ureteric orifices, and to identify and remove abnormal entities such as calculi or sutures in the bladder.

• #1 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  MRI arguably represents the best imaging modality to visualise the normal pelvic and perineal structures including the anal sphincter muscles and to elucidate suspected vaginal disorders. […] Therefore, if allowed by the patients clinical conditions, MRI is the preferred imaging modality to investigate suspected urethro-, vesico-, ano- and recto-VF. […] CT studies should include at least a portal-venous phase of enhancement after intravenous injection of CM and should be carefully interpreted using focused small-FOV axial and sagittal viewing along the anatomical orientation of the vagina. […] In patients with suspected VF, a vaginal tampon may be placed before performing either CT-urography or CT-cystography. […] Finally, CT-vaginography combines the cross-sectional anatomy with functional information concerning patency of the VF, but is cumbersome as it requires inflation of a Foley catheter into the vagina followed by injection of CM. […] With appropriate acquisition and focused interpretation, state-of-the art CT and MRI provide optimal visualisation of entero- and urinary VF that is crucial for correct therapeutic choice and surgical planning.

• #1

  https://link.springer.com/article/10.1007/BF02058713

  PURPOSE: Vaginal fistulas are rare but can cause extremely distressing symptoms for patients and prove difficult to define anatomically. Barium studies have been reported as having a maximum sensitivity of only 34 percent for detection of vaginal fistulas. Vaginography is an alternative method for diagnosis and evaluation of suspected vaginal fistulas, which has been reported to have a sensitivity of 100 percent. […] Vaginography successfully identified 19 of 24 fistulas, giving a sensitivity of 79 percent. […] Even allowing for this reduction, vaginography is still the most sensitive, economic, and informative investigation for identification and delineation of vaginal fistulas. We recommend that vaginography be the initial investigation of choice in patients with clinically suspected vaginal fistulas.

• #1 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  Transvaginal ultrasonography may clearly visualize the exact size, site, and course of the fistula. […] Contrast studies, such as a multiphasic CT urogram, are recommended before proceeding with surgical repair to identify concomitant ureteral fistulas or abnormalities. […] The primary complication of vesicovaginal fistula surgery is recurrent fistula formation. […] The diagnosis is traditionally established utilizing clinical evaluation and tampon dye testing.

• #1 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-016-0131-2

  Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). […] All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. […] The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. […] The clinical diagnosis of simple RVF (only one relatively short tube) based on medical history and anovaginal digital or probe examination is generally not difficult. However, for complex RVF i.e., RVF with branches and concomitant rectovaginal septum abscesses or perianal or perineal abscesses, the diagnosis must rely on imaging examinations.

• #1

  https://drmaherabbas.com/colorectal-conditions/rectovaginal-fistula/

  A rectovaginal fistula is a condition best described as a tunnel that communicates between the rectum and the vagina. […] The history and physical examination are often sufficient to make the diagnosis. An office-based examination includes visual inspection, probing of any vaginal or skin opening with a thin metal probe, a finger examination, and Anoscopy or Proctoscopy to look inside the anus and the rectum. […] One or more of the following tests may be recommended to complete the evaluation: Endoscopic examination: Colonoscopy to assess the large bowel (colon and rectum). […] Vaginoscopy is an examination where the inside of the vagina is inspected using special instruments to document the presence and location of the fistula. […] Some rectovaginal fistulas are very narrow and difficult to find during the office visit or additional testing. Under such circumstance, it may be necessary to perform an examination under anesthesia in the operating room in order to employ various maneuvers to identify the fistula.

• #1 Vesicovaginal Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564389/

  Vesicovaginal fistula is an anomalous communication between the bladder and vagina, resulting in continuous urine leakage through the vagina. […] This condition must be accurately diagnosed and treated in a timely fashion. […] The diagnostic workup should be comprehensive as most vesicovaginal fistulae require definitive surgical management. […] The diagnosis can be confirmed by completing a tampon dye test. […] The diagnosis of a vesicovaginal fistula can be made in an outpatient clinical setting. […] A thorough evaluation of the size, number, and location of the fistula is important before curative surgery is undertaken. […] Office cystoscopy and contrast studies, such as computed tomography (CT) urogram, are generally used to aid in the diagnosis of additional injuries. […] The diagnosis is traditionally established utilizing clinical evaluation and dye testing.

• #1 Rectovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/193277-workup

  Flexible endoscopy (sigmoidoscopy or colonoscopy) is used to fully evaluate the possibility of inflammatory bowel disease (IBD; more often Crohn disease than ulcerative colitis). Because treatment varies according to the diagnosis, endoscopy with biopsies must precede any operative approach to the fistula when IBD is in the differential diagnosis. […] Histology is most important in the evaluation of possible IBD. Neither a diagnosis of ulcerative colitis nor a diagnosis of Crohn disease completely excludes operative repair of an RVF, but operative planning is altered, as is the prognosis. If the rectum is grossly normal in Crohn disease, the prognosis of RVF repair is fair; if the rectum is abnormal, the prognosis is considerably worse. With any fistula considered suggestive of a primary or recurrent neoplasm, the histopathology is of the utmost importance.

• #1 Uretero-vaginal fistulas — clinical presentation, treatment and literature overview | Pyra | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/86882

  A uretero-vaginal fistula (UVF) describes an abnormal connection between the ureter and vagina causing urinary incontinence, frequent infection, and discomfort. […] Although UVF might be diagnosed after vaginal delivery, infertility treatment or pelvic radiation therapy, gynecological operations, especially total abdominal hysterectomy, remain the leading cause of ureteral injury and formation of UVF. […] Traditional ureteroneocystostomy was usually the treatment of choice in patients with UVF. […] Nevertheless, it is now frequently replaced by less invasive endoscopic and percutaneous procedures which are also highly effective and feasible. […] That is why, ureteral stenting became the first-line treatment in uncomplicated UVF. […] The aim of this review is to present clinical presentation of UVF and to assess the current state of knowledge about the diagnosis and management of uretero-vaginal fistula with special interest on minimally-invasive methods.

• #1 Uretero-vaginal fistulas — clinical presentation, treatment and literature overview | Pyra | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/86882

  Despite all methods mentioned above, some authors state that overall rate of ureteral injury during gynecological surgery, which may lead to creation of UVF is much higher than reported. […] That is why, they suggest that the routine intraoperative cystoscopy during major gynecologic and especially urogynecologic surgery might prevent sequelae from lower urinary tract injuries. […] Ureterovaginal fistula is rare yet important post-operative complication and should therefore be included in the differential diagnosis in patients reporting post-operative urinary incontinence. […] Early and correct diagnosis is crucial and can be made in the clinical setting with a simple dual-dye tampon test. […] Proper treatment selection is of great importance as minimally invasive ureteral stenting is associated with high cure rates and low morbidity compared with surgery in eligible patients.

• #1 Uterovesical fistulas as obstetric complications: Diagnosis, management and prognosis (Review)

  https://www.spandidos-publications.com/10.3892/etm.2023.11804

  Urogenital fistulas are abnormal communications between the female genital and urinary tract; while such fistulas, which are the most commonly encountered, are located between the vagina and urinary bladder and are caused by the local extension of a tumoral process. […] However, many questions regarding the diagnosis and management of uterovesical fistulas remain unanswered. […] Therefore, the aim of this article was to review the existent data so far, with special attention being focused on the pathogenic mechanisms leading to this complication, on the modalities of diagnosis, and on the possible therapeutic strategies. […] Therefore, according to the time of diagnosis, uterovesical fistulas can be classified as early fistulas, diagnosed in the first months postoperatively and late fistulas, diagnosed within several years from the initial surgical procedure.

• #1 Uterovesical fistulas as obstetric complications: Diagnosis, management and prognosis (Review)

  https://www.spandidos-publications.com/10.3892/etm.2023.11804

  For early fistulas, a conservative therapeutic strategy can be taken in consideration, while in cases diagnosed after a longer period of time, a surgical approach should be taken into consideration. […] Meanwhile, although a surgical approach can cure most of the cases, attention should be given towards preventive strategies such as provision of quality obstetric care with improvements of surgical skills. […] Most cases can be easily diagnosed during clinical examination and anamnesis; however, in order to confirm the diagnosis and to identify the site and trajectory of the fistulous path, imagistic studies are needed. […] Therefore, information obtained during standard clinical examination should be completed with those obtained during pelvic examination under anesthesia, cystourethrography, intravenous pyelography, sonohysterosalpingography, cystourethroscopy or hysteroscopy.

• #1 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  If there is a suspicion of malignancy, a biopsy must be taken for histologic examination. […] Successful closure of a VVF requires an accurate and a timely repair using procedures that exploit basic surgical principles. […] The rate of successful fistula repair reported in the literature varies between 70 and 100 % in non-radiated patients, with similar results when a vaginal or abdominal approach is performed; the mean success rates being 91 and 97 %, respectively. […] The arguments about the most appropriate route for repair continue and are not clarified by the publications so far.

• #1 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  CT-urography and additional CT-cystography now represent the mainstay techniques to diagnose urinary VF. […] The majority of patients with VF are initially referred to a gynaecologist; however, despite more or less evident clinical signs, vaginal exploration may identify the fistulous orifice in less than 80% of cases. […] As a result, clinicians and surgeons need critical help from radiologists to (1) confirm the presence of a VF, (2) visualise its site, course and involved organs, and (3) characterise the underlying pathology. […] In recent years, CT and MRI studies are largely replacing conventional radiologic techniques. […] With appropriate acquisition and focused interpretation, state-of-the art cross-sectional imaging may provide optimal visualisation of VF, involved organs and underlying diseases, which is crucial for correct choice between conservative and surgical treatment and appropriate surgical planning.

• #2 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. […] The diagnosis of the condition has traditionally been based on clinical methods and dye testing. […] The evaluation of size, number, and exact location of fistula is important before curative surgery is undertaken. Better preoperative diagnosis allows better surgical planning. […] Postoperative patients with a VVF usually are easily diagnosed with urine leaking through the vagina. […] The diagnosis can be established by filling the bladder with a dilute solution of methylene blue. […] Physical examination is of vital importance. […] Further diagnostic procedures should include retrograde and voiding the cysto-urethrography. […] The advanced but more invasive and/or costlier techniques include combined vaginoscopy-cystoscopy, subtraction magnetic resonance fistulography, and endocavitary ultrasound through transrectal or more properly through transvaginal route with or without Doppler or contrast agents.

• #2 Vaginal fistula: Types, symptoms, and causes

  https://www.medicalnewstoday.com/articles/vaginal-fistula

  To diagnose a vaginal fistula, a doctor will first review a persons medical and surgical history. They may identify possible causes, such as recent pelvic surgery, childbirth, radiation therapy in the pelvic area, or a condition such as Crohns disease. […] They will also assess a persons symptoms and perform a thorough physical and pelvic exam. This will include a speculum exam and potentially a rectal exam if the doctor suspects a person has a rectovaginal fistula. They may order additional imaging tests to rule out other conditions and confirm the presence of a vaginal fistula. For example, diagnosis of a vesicovaginal fistula may involve: […] a cystoscopy exam to visualize the inside of the bladder […] a CT scan or voiding cystourethrogram to further check the area […] a dye test, where the doctor inserts dye into the bladder to help identify leakage […] a retrograde pyelogram, which helps visualize the kidneys, ureters, and bladder […] an MRI, CT, or a fistulogram, to produce images of the pelvic area and fistula.

• #2 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  To diagnose a rectovaginal fistula, your health care provider will likely talk to you about your symptoms and do a physical exam. Your provider may suggest certain tests depending on your needs. […] Most commonly, a rectovaginal fistula is easily seen during a pelvic exam. If a fistula is not found during the exam, you may need tests. These tests can help your medical team find and look at a rectovaginal fistula and can help plan for surgery, if needed. […] A CT scan of your abdomen and pelvis gives more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause. […] This test creates images of soft tissues in your body. MRI can show the location of a fistula, whether other pelvic organs are involved or whether you have a tumor. […] If other testing does not find a fistula, your surgeon may need to examine you in the operating room. This allows for a thorough look into the anus and rectum and can help locate the fistula and help plan surgery.

• #2 The diagnosis and surgical repair of vesicovaginal fistula | MDedge

  https://www.mdedge.com/obgyn/article/170911/surgery/diagnosis-and-surgical-repair-vesicovaginal-fistula/page/0/1

  I recommend beginning the work-up for a suspected VVF with a thorough cystoscopic evaluation of the bladder for injury. An irregular appearance of the bladder, signs of inflammation, and poor or absent ureteral efflux are often indicative of VVF in the presence of vaginal leakage. […] Following cystoscopy, I perform a split speculum examination of the vagina. Most injuries will be on the anterior wall or the apex (cuff). A recently formed fistula may appear as a hole or as a small, red area of granulation tissue with no visible opening. […] Leakage in the vagina can sometimes be detected with a retrograde filling of the bladder; other times, it is possible to detect leakage without filling the bladder. In all cases, it’s important to remember that more than one fistula – and more than one fistula type – may be present. A VVF and ureterovaginal fistula will sometimes occur together, which means that abnormal cystoscopy findings in a patient who experiences leakage does not necessarily rule out the presence of a concurrent ureterovaginal fistula.

• #2 Vaginal Fistula: Types, Symptoms, Causes, Treatments

  https://www.webmd.com/women/what-is-a-vaginal-fistula

  Your doctor will do a pelvic exam and ask about your medical history to see if you have any risk factors for fistulas, like a recent surgery, infection, or pelvic radiation. […] They may also order some tests, including: […] Dye test. Your doctor will fill your bladder with a dye solution. Theyll ask you to cough or bear down. If you have a vaginal fistula, the dye will leak into your vagina. […] Cystoscopy. Your doctor uses a thin device called a cystoscope to look inside your bladder and urethra for signs of damage. […] X-rays: […] Retrograde pyelogram. This is a special test in which dye is injected through your bladder into your ureters. An X-ray can show whether there is leakage between a ureter and your vagina. […] Fistulogram. This is an X-ray image of your fistula. It can show your doctor whether you have one or many fistulas and if other pelvic organs may be involved.

• #2 Vesicovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/267943-workup

  Staining of the apical tampon would implicate the vaginal apex or cervix/uterus/fallopian tube; staining of a distal tampon raises suspicion of a urethral fistula. […] Evidence of staining or wetting of a tampon should then prompt the physician to proceed with additional diagnostic testing prior to proceeding with definitive management. […] Color Doppler ultrasonography with contrast media of the urinary bladder may be considered in cases where cystoscopic evaluation is suboptimal, such as in those patients with severe bladder wall changes like bullous edema or diverticula.

• #2 Vesicovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/267943-workup

  In patients with a history of local malignancy, a biopsy of the fistula tract and microscopic evaluation of the urine is warranted. […] Radiologic studies should be employed prior to surgical repair of a VVF. An intravenous urogram (IVU) is necessary to exclude ureteral injury or fistula because 10% of VVFs have associated ureteral fistulas. […] If suspicion is high for a ureteral injury or fistula and the IVU findings are negative, retrograde ureteropyelography should be performed at the time of cystoscopy and examination under anesthesia. […] Intraoperative assessment for bladder or ureteral injury may be performed by administering indigo carmine intravenously and closely observing for any subsequent extravasation of dye into the pelvis. […] A cystoscopic examination with a small scope (eg, 19F) may be used to identify VVF in the bladder or urethra, to determine the number and location and proximity to ureteric orifices, and to identify and remove abnormal entities such as calculi or sutures in the bladder.

• #2 Vaginal Fistula: Types, Symptoms, Causes, Treatments

  https://www.webmd.com/women/what-is-a-vaginal-fistula

  Flexible sigmoidoscopy. Your doctor looks at your anus and rectum with a sigmoidoscope (a thin, flexible tube with a tiny video camera at the tip). […] CT urogram. You have dye injected into a vein, and CT scans make images of your vagina and urinary tract. […] Pelvic MRI. A magnetic field and radio waves take detailed pictures of your rectum and vagina to help show the details of a rectovaginal fistula.

• #2 Rectovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/193277-workup

  Flexible endoscopy (sigmoidoscopy or colonoscopy) is used to fully evaluate the possibility of inflammatory bowel disease (IBD; more often Crohn disease than ulcerative colitis). Because treatment varies according to the diagnosis, endoscopy with biopsies must precede any operative approach to the fistula when IBD is in the differential diagnosis. […] Histology is most important in the evaluation of possible IBD. Neither a diagnosis of ulcerative colitis nor a diagnosis of Crohn disease completely excludes operative repair of an RVF, but operative planning is altered, as is the prognosis. If the rectum is grossly normal in Crohn disease, the prognosis of RVF repair is fair; if the rectum is abnormal, the prognosis is considerably worse. With any fistula considered suggestive of a primary or recurrent neoplasm, the histopathology is of the utmost importance.

• #2 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  Vaginal fistulas (VF) represent abnormal communications between the vagina and either the distal portion of the digestive system or the lower urinary tract, but lack an accepted classification and standardised terminology. […] Since diagnosis of VF is challenging at gynaecologic examination, ano-proctoscopy and urethro-cystoscopy, imaging is crucial to confirm the fistula, to visualise its site, course and involved organ, and to characterise the underlying disease. […] The traditional conventional radiographic studies provided limited cross-sectional information and are nowadays largely replaced by CT and MRI studies. […] CT diagnosis of bowel vaginal fistulas benefits from small field-of-view oblique and sagittal interpretation, and optional intrarectal contrast. […] If not contraindicated, focused MRI provides superior visualisation of ano- and rectovaginal fistulas.

• #2 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  CT-urography and additional CT-cystography now represent the mainstay techniques to diagnose urinary VF. […] The majority of patients with VF are initially referred to a gynaecologist; however, despite more or less evident clinical signs, vaginal exploration may identify the fistulous orifice in less than 80% of cases. […] As a result, clinicians and surgeons need critical help from radiologists to (1) confirm the presence of a VF, (2) visualise its site, course and involved organs, and (3) characterise the underlying pathology. […] In recent years, CT and MRI studies are largely replacing conventional radiologic techniques. […] With appropriate acquisition and focused interpretation, state-of-the art cross-sectional imaging may provide optimal visualisation of VF, involved organs and underlying diseases, which is crucial for correct choice between conservative and surgical treatment and appropriate surgical planning.

• #2 Vesicovaginal fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/vesicovaginal-fistula-2?lang=us

  Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in an involuntary discharge of urine through the vagina. […] A fluoroscopic cystogram is a commonly-used method for evaluating this type of fistula. Contrast is injected into the bladder through a Foley catheter, and the fistulous tract is outlined. A number of oblique and lateral projections are needed to determine the location. […] The fistula may be seen as a hypodense area with excretion of contrast into the vagina on delayed CECT images. The tract may be visible if a CT cystogram is performed. […] CT, in addition, may provide details regarding the cause of the fistula, such as an adjacent pelvic mass or bowel thickening. […] T1: tract is centrally hypointense (fluid) […] T2: tract is hyperintense with gas bubbles seen as low signal intensities […] T1 C+ (Gd): peripheral enhancement on contrast.

• #2 Elucidating vaginal fistulas on CT and MRI | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0812-9

  MRI arguably represents the best imaging modality to visualise the normal pelvic and perineal structures including the anal sphincter muscles and to elucidate suspected vaginal disorders. […] Therefore, if allowed by the patients clinical conditions, MRI is the preferred imaging modality to investigate suspected urethro-, vesico-, ano- and recto-VF. […] CT studies should include at least a portal-venous phase of enhancement after intravenous injection of CM and should be carefully interpreted using focused small-FOV axial and sagittal viewing along the anatomical orientation of the vagina. […] In patients with suspected VF, a vaginal tampon may be placed before performing either CT-urography or CT-cystography. […] Finally, CT-vaginography combines the cross-sectional anatomy with functional information concerning patency of the VF, but is cumbersome as it requires inflation of a Foley catheter into the vagina followed by injection of CM. […] With appropriate acquisition and focused interpretation, state-of-the art CT and MRI provide optimal visualisation of entero- and urinary VF that is crucial for correct therapeutic choice and surgical planning.

• #2 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-016-0131-2

  Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). […] All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. […] The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. […] The clinical diagnosis of simple RVF (only one relatively short tube) based on medical history and anovaginal digital or probe examination is generally not difficult. However, for complex RVF i.e., RVF with branches and concomitant rectovaginal septum abscesses or perianal or perineal abscesses, the diagnosis must rely on imaging examinations.

• #2 Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula | BMC Medical Imaging | Full Text

  https://bmcmedimaging.biomedcentral.com/articles/10.1186/s12880-016-0131-2

  Endoluminal ultrasonography exhibits relatively high sensitivity and positive predictive value in the diagnosis of RVF internal openings and fistula morphology. […] In summary, diagnosing RVF using transrectal endoluminal biplane ultrasonography can not only accurately determine the internal openings in the rectum or vagina but also relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum.

• #2 Rectovaginal Fistula Workup: Laboratory Studies, Imaging Studies, Endoscopy

  https://emedicine.medscape.com/article/193277-workup

  Laboratory studies (eg, complete blood count [CBC], blood cultures, electrolytes, blood urea nitrogen [BUN], creatinine, and type and screen) are obtained to assess for sepsis, which is extremely rare in fistulas between the gastrointestinal (GI) tract and the female genital tract. Laboratory studies are also helpful in the establishment of preoperative baselines. […] Ancillary studies may illustrate a rectovaginal fistula (RVF) that is elusive on physical examination. Barium enema can demonstrate RVF or the more common sigmoidvaginal cuff fistula observed in diverticulitis. Computed tomography (CT) often shows perifistular inflammation, identifying the responsible digestive organ. Endorectal and transvaginal ultrasonography (US) may be used to help identify low fistulas. Magnetic resonance imaging (MRI) has been employed in the diagnosis of RVFs.

• #2 Vesicovaginal Fistula: Diagnosis and Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4039689/

  If there is a suspicion of malignancy, a biopsy must be taken for histologic examination. […] Successful closure of a VVF requires an accurate and a timely repair using procedures that exploit basic surgical principles. […] The rate of successful fistula repair reported in the literature varies between 70 and 100 % in non-radiated patients, with similar results when a vaginal or abdominal approach is performed; the mean success rates being 91 and 97 %, respectively. […] The arguments about the most appropriate route for repair continue and are not clarified by the publications so far.

• #2

  https://drmaherabbas.com/colorectal-conditions/rectovaginal-fistula/

  A rectovaginal fistula is a condition best described as a tunnel that communicates between the rectum and the vagina. […] The history and physical examination are often sufficient to make the diagnosis. An office-based examination includes visual inspection, probing of any vaginal or skin opening with a thin metal probe, a finger examination, and Anoscopy or Proctoscopy to look inside the anus and the rectum. […] One or more of the following tests may be recommended to complete the evaluation: Endoscopic examination: Colonoscopy to assess the large bowel (colon and rectum). […] Vaginoscopy is an examination where the inside of the vagina is inspected using special instruments to document the presence and location of the fistula. […] Some rectovaginal fistulas are very narrow and difficult to find during the office visit or additional testing. Under such circumstance, it may be necessary to perform an examination under anesthesia in the operating room in order to employ various maneuvers to identify the fistula.

• #2 Uretero-vaginal fistulas — clinical presentation, treatment and literature overview | Pyra | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/86882

  In case of UVF suspicion, all patients should undergo thorough history and physical examination. […] Most common clinical presentation of UVF include continuous vaginal leak of urine with or without ipsilateral flank, fever and urinary tract infection which typically occur up to four weeks after the ureteral injury. […] The diagnostic method of choice to diagnose various types of vaginal fistulas, including UVF is a double-dye tampon test during which one dye is injected to the patients bladder and the second dye of different color is injected intravenously. […] The staining on the packs removed from patients vagina indicate the localization of the fistula. […] Its main advantages are low costs, simplicity and high accuracy. […] As far as the imaging examinations are concerned, CT-urography is the most commonly used diagnostic modality and is considered to be the gold standard for the detection of ureteral injury, including fistula.

• #2 Uterovesical fistulas as obstetric complications: Diagnosis, management and prognosis (Review)

  https://www.spandidos-publications.com/10.3892/etm.2023.11804

  For early fistulas, a conservative therapeutic strategy can be taken in consideration, while in cases diagnosed after a longer period of time, a surgical approach should be taken into consideration. […] Meanwhile, although a surgical approach can cure most of the cases, attention should be given towards preventive strategies such as provision of quality obstetric care with improvements of surgical skills. […] Most cases can be easily diagnosed during clinical examination and anamnesis; however, in order to confirm the diagnosis and to identify the site and trajectory of the fistulous path, imagistic studies are needed. […] Therefore, information obtained during standard clinical examination should be completed with those obtained during pelvic examination under anesthesia, cystourethrography, intravenous pyelography, sonohysterosalpingography, cystourethroscopy or hysteroscopy.

• #2 Uterovesical fistulas as obstetric complications: Diagnosis, management and prognosis (Review)

  https://www.spandidos-publications.com/10.3892/etm.2023.11804

  In this respect, the presence of a utero-vesical communication should be more facile to be demonstrated during exploratory studies regarding the genital tract such as hysterosalpingography or hysteroscopy; therefore intracavitary injection of contrast during hysterosalpingography will lead to the exteriorization of the substance at the level of the urinary tract. […] In order to complete the data obtained at hysterosalpingography, a hysteroscopy might be associated; therefore, during this investigation direct visualization of the uterine cavity as well as the presence of the fistulous orifice might be demonstrated. […] Meanwhile, depending on the dimensions of the orifice, it can be further explored and the trajectory can be identified. […] During the same intervention, explorative cystoscopy can be also associated in order to confirm the presence of the second orifice of the fistulous trajectory at the level of the urinary bladder; meanwhile the distance between the fistulous orifice, the ureteral ostiums and urethra can be further evaluated.

• #2 Rectovaginal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/diagnosis-treatment/drc-20377113

  In most cases, surgery is needed to close or repair a rectovaginal fistula. Before an operation can be done, the skin and other tissue around the fistula should be free of infection or inflammation. […] The goal is to remove the fistula tunnel and close the opening by sewing together healthy tissue. […] If a colostomy is needed, your surgeon may wait 3 to 6 months. Then if your provider is sure that your fistula has healed, the colostomy can be reversed so that stool again passes through the rectum.

• #2 Rectovaginal Fistula – Your Pelvic Floor

  https://www.yourpelvicfloor.org/conditions/rectovaginal-fistula/

  The success rate for rectovaginal fistula repair is high, ranging from 90-95%. Patients with recurrent fistulas or a history of radiation may have a poorer outcome. Fecal incontinence, even with successful fistula repair, up to 30-40% of women may still experience fecal incontinence with leakage of stool or gas from the anus, especially if the fistula involved the anal muscles.

• #3 Vesicovaginal Fistula: Symptoms, Diagnosis, and Treatment

  https://www.healthline.com/health/womens-health/vesicovaginal-fistula

  How is Vesicovaginal fistula (VVF) diagnosed? Properly diagnosing VVF and getting as much information as possible about it prior to surgery is important. While self-reports are helpful, there are tests as well. The following exams and tests may be performed to help diagnose VVF: Physical exam. The area where the fistula is will be examined for inflammation or other abnormalities. This can help determine the best surgical approach for repair. Imaging tests. A doctor or healthcare professional may order imaging tests such as pelvic X-ray, CT scan, and CT scan with contrast in order to see how your bladder and uterus look and exactly where the fistula or hole has developed. Double dye test. In this test, your bladder is filled with a solution thats dyed blue and then a tampon is inserted into your vagina. If the tampon turns blue, a VVF is present. Cystourethroscopy. A cystoscopy can also help clarify exactly where the VVF is. This can help further aid in treatment planning.

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