Most impoant manifestation of ureterovaginal fistula is: September 2009

Ans. D: Continuous Incontenence The uncontrolled leakage of urine into the vagina is the hallmark symptom of patients with vesicovaginal fistulas. Patients may complain of urinary incontinence or an increase in vaginal discharge following pelvic surgery or pelvic radiotherapy with or without antecedent surgery. The drainage may be continuous; however, in the presence of a very small vesicovaginal fistula, it may be intermittent. Recurrent cystitis or pyelonephritis, abnormal urinary stream, and hematuria also should initiate a workup for vesicovaginal fistula. The time from initial insult to clinical presentation depends on the etiology of the vesicovaginal fistula. A vesicovaginal fistula secondary to a bladder laceration typically presents immediately. Approximately 90% of genitourinary fistulas associated with pelvic surgery are symptomatic within 7-30 days postoperatively. An a:lterior vaginal wall laceration associated with obstetric fistulas typically (75%) presents in the first 24 hours of delivery. In contrast, radiation-induced UGFs are associated with slowly progressive devascularization necrosis and may present 30 days to 30 years later. Patients with radiation-induced VVFs initially present with symptoms of radiation cystitis, hematuria, and bladder contracture.