A 48-year-old woman who underwent total abdominal hysterectomy for fibroids 10 days ago presents with continuous leakage of clear fluid per vaginam. The creatinine level of the fluid is markedly higher than serum creatinine. What is the most likely diagnosis?

• A Rectovaginal fistula
• B Vesicovaginal fistula
• C Peritoneal pseudocyst draining through the vault
• D Ureterovaginal fistula ✓

Explanation

Continuous urinary leakage after pelvic surgery suggests a urogenital fistula. Fluid creatinine markedly higher than serum points to urine, confirming a urinary tract fistula. Ureterovaginal fistula typically follows injury to the pelvic ureter near the uterine artery during hysterectomy and presents about 7 to 14 days later. In vesicovaginal fistula the fluid creatinine equals serum creatinine because bladder urine has already equilibrated, which distinguishes the two. A three-swab test further localises the site of leakage.

Reference: Smith and Tanagho's General Urology, 19th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.