A 45-year-old woman presents with continuous urinary leakage day and night following a difficult instrumental delivery 3 months ago. She has no urgency or stress incontinence. Dye test (methylene blue in bladder) stains the vaginal swab blue. The MOST likely diagnosis is:

• A Urge urinary incontinence
• B Ureterovaginal fistula
• C Overflow incontinence from urethral obstruction
• D Vesicovaginal fistula ✓

Explanation

Continuous uncontrolled urinary leakage without urgency after obstetric trauma, combined with a positive dye test (methylene blue in the bladder stains vaginal pad), confirms a vesicovaginal fistula. In ureterovaginal fistula, the bladder dye test would be negative (urine leaking bypasses the bladder) — a ureterovaginal fistula is diagnosed by intravenous urography or CT urogram. The history of difficult delivery with subsequent continuous leakage is classic for obstetric VVF.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.