A 42-year-old woman notices constant dampness in her underclothes two weeks after total abdominal hysterectomy for fibroids. She continues to void normally per urethra several times a day. The most likely diagnosis is:

• A Vesico-vaginal fistula
• B Detrusor overactivity
• C Urethro-vaginal fistula
• D Uretero-vaginal fistula ✓

Explanation

Preserved normal micturition alongside continuous vaginal leakage points to a uretero-vaginal fistula: urine bypasses the bladder entirely via an injured lower ureter, so bladder capacity and voiding are unaffected. In vesico-vaginal fistula the patient loses all urine vaginally and cannot void normally because the bladder never fills. Confirmation is by intravenous urography or CT urogram showing contrast extravasation and hydroureter.

Reference: DC Dutta's Textbook of Gynecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.