Which is the most common cause of the type of fistula ‘2’ shown in the photograph below in india ?
A. Gynae Surgery.
C. Obstructed labour.
The type of fistula ‘2’ shown in the photograph above represents vesicovaginal fistula.
90% of the bladder fistula in India is due to obstructed labour, and remaining 10% is due to surgery and cancer treatment. The two types of bladder fistulae are vesicovaginal and uterovesical.
Obstructed labour can occur due to contracted pelvis and fetal malpresentation. During this the bladder neck and the vagina are compressed between the pubic bone and the fetal head for a long period and undergo ischaemic necrosis. 5 to 7 days later the necrosed area sloghs off and a fistula is formed.
Other causes of vesicovaginal fistula are:
- Rupture of uterus
- Cesarean section
- Kielland forceps can injure the bladder during rotational delivery
- Abdominal hysterectomy for PID, endometriosis and cervical fibroid
- Radiotherapy cause bladder fistula few months to 2 years due to ischemic vascular necrosis
- TB, cancer of lower genital tract, and rarely a bladder stone and perforated IUCD.