Kamla, a 48 years old lady underwent hysterectomy on the seventh day. She developed fever burning micturition and continuous urinary dribbling. She can also pass urine voluntarily. The diagnosis is-

Ans. is 'd' Uretherovaginal fistula (Ref. Shaws, 13/e, p 181 (12th/e, p. 149)). History of previous operation (hysterectomy) and the symptom (Continuous dribbling of urine in the patient) has made it very easy for us to rule out stress incontinence and urge incontinence. Continuous dribbling of urine is a classic feature of urinary fistulas and they are common after gynecological operations. In stress incontinence, dribbling of urine occurs only when intraabdominal pressure is raised. In urge continence, the patient must pass urine at a moment's notice and unless she is quick about it she is unable to control her bladder. Now we are left with 2 options uretherovaginal fistula and vesicovaginal fistula. The passing of urine voluntarily clinches the diagnosis in favor of uretherovaginal fistula as voluntary passing of urine is seen only in ureterovaginal fistula. In vescico vaginal fistula no urine allowed to collect in the bladder.