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RECTOVAGINAL FISTULAE
mostly asymptomatic
Stage Criteria for stage 0 are not met, but the most distal portion of
the prolapse is >1cm above the level of the hymen.
I
Stage The most distal portion of the prolapse is less or equal to 1cm
proximal or distal to the plane of the hymen.
II
Stage The most distal portion of the prolapse is >1cm below the
plane of the hymen but protrudes no farther than 2cm less
III than the total vaginal length in cm.
Strain
Urethral Diverticula
Cystocoele and
• more reducible, very
urethrocoeles
prominent sensation of a
mass
• Pus may be expressed
• softish, pliable
Bladder tumors and
and nontender
diverticula
• less common
Management
Nonoperative Pessary
large tampons
Kegel’s exercises
Patient Straining
education to
heavy lifting
avoid the
following for at prolonged standing
least 3 months:
Rectocoele
• Protrusion of the rectum into the posterior vaginal wall
due to weakness of rectal supports
RECTOCOELE
Signs and Symptoms
Pelvic heaviness
“falling out”
Constipation
Incomplete emptying
Physical
Examination Rectum bulge into the vagina when
the patient is instructed to strain
Rectovaginal septum is paper thin
Differentials
for Sigmoidocoele
evacuation
problems Rectal prolapse
Rectal intussuception
Management
Nonoperative Pessary
kegel’s
estrogen cream
dietary fibers
increased fluids
Regular exercise
colorectal screening test for GI symptoms
Management
Operative
anterior and posterior
colporrhaphy
correction of concomittant
enterocoele or descensus
perineorraphy
Enterocele
Herniation of the pouch of douglas between
the uterosacrals into the rectovaginal septum
PE reveals it as a separate
bulge above a rectocele
Transillumination
Management
• Transabdomination reduction done at the time of the
primary repair
Management
Abdominal Necessary for resuspension and
sacrocolpopexy closure of enterocoele defect
Obesity
congenital
Signs and symptoms
Heaviness, fullness, falling out
Stage 2 Pessary
estrogen creams
Kegel’s
Backache
Introital mass
PLUS perineorrhaphy
Rectovaginal Fistulas
A common complication of birth and gyne procedures
Neoplastic
Rectovaginal Fistula
Rectovaginal
Fistula (RVF) true RVF are located
more than 3 cm above
anal verge
Anovaginal
Fistula (AVF) fistula caudad or adjacent
to EAS and is managed
differently from RVF
RVF from obstetric injury
Lower 3rd of the vagina
Mandates
biopsy to rule
out cancer as a
cause
Clinical manifestations
Small
asymptomatic or small amounts
of flatus passing into the vagina
Large
formed stools from the vagina
Neoplastic
process/ Rectal bleeding
postradiation
Diagnosis
History and Office
Physical Colonoscopy proctoscopy
Exam or anoscopy
Peroxide via
Methylene Barium
angiocatheter
blue infusion Enema
infusion
Vaginography
Management
tract is opened, curreted and left to
AVF heal by secondary intention
antibiotic prophylaxis
stool softeners
Suprapubic
Burch
approach or a
procedure
vaginal sling
Burch procedure.
The lateral edges of the vagina have been sutured to the
Cooper's ligaments
Other Types of Incontinence
CONTINUOUS continuous leakage of urine
URINARY where the patient does not
INCONTINENCE describe urgency or activity
associated with the leakage
bladder is nonpainful and may be palpable after the patient has voided
END OF LECTURE