Clinical Presentation: A 30-year-old female presents with continuous urinary incontinence and recurrent urinary tract infections following prolonged obstructed labor during childbirth. She reports leakage of urine per vaginam and persistent foul odor. Pelvic examination reveals a small opening between the bladder and vagina with pooling of urine. What is the likely diagnosis, and how should this condition be managed? Answer: The likely diagnosis is a vesicovaginal fistula. Management involves surgical repair of the fistula under general anesthesia. Preoperative optimization of the patient's nutritional status, urinary tract management, and treatment of urinary tract infections are essential. Surgical repair may be performed transvaginally, transabdominally, or laparoscopically, depending on the size and location of the fistula. Explanation: Vesicovaginal fistulae are abnormal connections between the bladder and vagina, leading to continuous urinary leakage through the vaginal vault. They commonly occur as a result of obstetric trauma, particularly prolonged or obstructed labor. Management involves surgical repair to restore urinary continence and improve quality of life. Preoperative evaluation should include assessment of the fistula size, location, and associated urinary tract pathology to optimize surgical outcomes and prevent recurrence.
