How are ureterovaginal and vesicovaginal fistula differentiated in the postoperative workup of iatrogenic ureteral injury?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Postoperatively, if any drainage is noted from the vagina, an attempt should be made to diagnose a ureterovaginal or vesicovaginal fistula. This may be accomplished with a bedside test. In this test, a tablet of oral phenazopyridine (eg, Pyridium) is administered. The bladder is instilled via a catheter with saline that is colored with methylene blue. A vaginal tampon is inserted. Since phenazopyridine turns the urine orange, if an orange liquid is observed on the end of the tampon, a presumptive diagnosis of a ureterovaginal fistula can be made. Alternatively, if the tampon absorbs a blue liquid, the diagnosis of vesicovaginal fistula can be made. However, since both types of fistulas may be present simultaneously, this test may not be completely reliable.

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