Most common cause of vesicovaginal fistula is: (Repeat)

Ans: C (Obstructed labour) Ref: DC Dutta s Textbook of Gynaecology 6th edition pg 401Explanation:VESICOVAGINAL FISTULAMC type of genito urinary fistulaCausesA. Obstetrical :Accounts for 80 % cases of VVF in developing countries5 - 15 % cases in developed countriesVVF may result from- Ischaemiao Obstructed labour : Ischaemic necrosis of the bladder base following prolonged compression of the bladder base between fetal head and pubic symphysis- infection - sloughing - fistula o Take 3-5 days following delivery to roduce ischaemic fistula o MC in developing countriesTraumatico Instrumental vaginal delivery -- Forceps - specially with Kielland's forceps-- Destructive operations-- Instruments used for Craniotomy procedure - perforators and cranioclasts-- Injury may be inflicted by bony spicule of fetal skullo Abdominal surgeries-- Hysterectomy for rupture uterus-- LSCS- Traumatic injuries manifests soon after deliveryB. Gynaecological causes:Accounts for 80 % fistulas in developed countriesMC type of VVF in developed countriesCausesOperative injury - anterior colporrhaphy, TAHTraumatic - illegal abortions, pelvic fracturesAdvanced malignancies of genital tract organsRadiation therapy for Ca cervixo Due to end arteritis obliteranso Takes long time to develop - 1-2 yrsInfective - vaginal TB. LGV. Schistosomiasis, ActinomycosisUretero vaginal fistulao 2nd common cause of urinary fistulao MC site of injury to ureter-- In hysterectomies - Ureteric tunnel in Mackenrodt's ligament-- In radical surgery for Ca cervix - Near crossing of pubocervical ligament