Posted by C S Loh on February 16, 1998 at 10:29:20:
In Reply to: Re: Fistula posted by CLDing on February 16, 1998 at 09:35:57:
It was a rather radical Wertheim done by 2 very reputable gynaecoloigists. I was asked by her urologist to repeat her urodynamics but on hearing her history, decided that urodynamics was not indicated. Like you, I always investigate both UT & LT in situations such as these. Her IVU post Wertheim had shown completely normal Rt. upper tract at that time. I believed methylene blue was instilled under high pressure into the baldder and no blue was seen in her vagina and rectum. Thus, what fistula there was had to come from the upper tract. Incidently, I don't use methylene blue in this situation but it is useful when you are looking for an ectopic ureter in a wet girl in which a colourless wet nappy is confirms the diagnosis. In this case, perhaps the lack of blue should have lent the clue that the problem was upper tract in origin. An IVU indeed confirmed this: this time the right ureter was dilated and CT scan confirmed contrast in both the vagina and rectum. It was interesting to note that her right UTwas completely normal immediately after her Wertheim - so you can't blame her urologist for missing it, although we must bear in mind that at that time, she had not developed the faecal fistula yet.
On exploration, I could not cannulate the RUO. The rectum and vaginal remnant and the
bladder base was one fibrotic mass. She had been dry since I re-implanted her right
ureter. I couldn't separate her vagina/rectum from her bladder. I plan to study her
defunctioned large bowel some 3 month post-op with a view of closing her colostomy.