You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information.
What is Most common cause of vesicovaginal fistula is: (Repeat) and explain in detail?
Ans: C (Obstructed labour) Ref: DC Dutta s Textbook of Gynaecology 6th edition pg 401Explanation:VESICOVAGINAL FISTULAMC type of genito urinary fistulaCausesA. Obstetrical :Accounts for 80 % cases of VVF in developing countries5 - 15 % cases in developed countriesVVF may result from- Ischaemiao Obstructed labour : Ischaemic necrosis of the bladder base following prolonged compression of the bladder base between fetal head and pubic symphysis- infection - sloughing - fistula o Take 3-5 days following delivery to roduce ischaemic fistula o MC in developing countriesTraumatico Instrumental vaginal delivery -- Forceps - specially with Kielland's forceps-- Destructive operations-- Instruments used for Craniotomy procedure - perforators and cranioclasts-- Injury may be inflicted by bony spicule of fetal skullo Abdominal surgeries-- Hysterectomy for rupture uterus-- LSCS- Traumatic injuries manifests soon after deliveryB. Gynaecological causes:Accounts for 80 % fistulas in developed countriesMC type of VVF in developed countriesCausesOperative injury - anterior colporrhaphy, TAHTraumatic - illegal abortions, pelvic fracturesAdvanced malignancies of genital tract organsRadiation therapy for Ca cervixo Due to end arteritis obliteranso Takes long time to develop - 1-2 yrsInfective - vaginal TB. LGV. Schistosomiasis, ActinomycosisUretero vaginal fistulao 2nd common cause of urinary fistulao MC site of injury to ureter-- In hysterectomies - Ureteric tunnel in Mackenrodt's ligament-- In radical surgery for Ca cervix - Near crossing of pubocervical ligament