Obstetric fistula: evaluation with ultrasonography

Area of Science:

• Urology
• Gynecology
• Diagnostic Imaging

Background:

• Obstetric fistulae are significant complications requiring accurate preoperative diagnosis.
• Intravenous urography (IVU) has limitations in visualizing certain genital abnormalities associated with fistulae.
• Real-time sonography offers a non-invasive imaging modality for evaluating these complex cases.

Purpose of the Study:

• To prospectively evaluate the utility of real-time sonography in the preoperative assessment of obstetric fistulae.
• To compare sonographic findings with IVU and examination under anesthesia (EUA).
• To identify the strengths and limitations of sonography in diagnosing fistulae and associated genital abnormalities.

Main Methods:

• Prospective examination of 22 patients with 24 obstetric fistulae using real-time sonography.
• Comparison of sonographic findings with IVU results.
• Correlation of sonographic findings with intraoperative findings and EUA.

Main Results:

• Sonography revealed genital abnormalities not detected by IVU, including cervical injuries and specific vesicovaginal fistula signs.
• Sonography successfully identified the site, size, and course of fistulae in 29% of cases.
• Examination under anesthesia identified 87% of fistulae, significantly higher than sonography.

Conclusions:

• Sonography is valuable for detecting genital abnormalities missed by IVU in obstetric fistula patients.
• Sonography's effectiveness in demonstrating fistulae is limited by factors like size and multiplicity.
• Sonography serves as a complementary tool to EUA for preoperative evaluation, especially in complex or previously repaired fistula cases.