Evaluation of Female Urinary Incontinence

, , University of Texas Medical School

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Detection of Fistulas

When leakage occurs during both the day and night, a vesicovaginal fistula must be suspected and investigated. Vesicovaginal fistula may be intermittent, in some cases with leakage occurring in association with movement and simulating stress incontinence. The association of leakage following gynecological surgery should prompt urologic investigation, especially if the postoperative course (for example, following hysterectomy) was complicated by fever, excessive abdominal pain, ileus, hematuria, or severe symptoms of bladder irritability.[24] Fistulas should be detected early after development and promptly repaired. Diagnosis of vesicovaginal fistula requires visualization of the fistula. This may be achieved during cystoscopy or fluoroscopically. An intravenous urogram should be performed to exclude a concomitant ureterovaginal fistula and establish that the upper urinary tracts are normal.

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