Question:hard
A 45 year old female patient underwent hysterectomy. On the 7th post-operative day she complains of continuous dribbling of urine and fever. Micturition was not voluntary. What is the diagnosis?
A 45 year old female patient underwent hysterectomy. On the 7th post-operative day she complains of continuous dribbling of urine and fever. Micturition was not voluntary. What is the diagnosis?
Show Hint
The uterus is already removed, so which structure in front of it leaks into the vagina?
Updated On: Jun 24, 2026
- Vesicovaginal fistula
- Ureterovaginal fistula
- Vesicouterine fistula
- Urethrovaginal fistula
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Identify the pattern. Urine that escapes all the time, with the woman unable to pass urine voluntarily, signals a leak between the urinary tract and the vagina rather than a storage or sphincter problem. The timing, about a week after hysterectomy, fits a surgical fistula.
Step 2: Test each option against the anatomy left after surgery. The uterus has been taken out, so no vesicouterine fistula can form, eliminating option (c) on logical grounds alone. A urethrovaginal fistula tends to leak only while voiding rather than continuously, so it does not match constant dribbling.
Step 3: That narrows it to a bladder or ureteric injury. The bladder sits directly in front of the cervix and uterus and is the organ most frequently injured at hysterectomy. A direct bladder-to-vagina opening produces ceaseless leakage with no voluntary control, which is exactly the described scenario. A ureterovaginal fistula usually still lets the bladder fill, so intermittent voluntary voiding persists, making it a less complete fit.
Step 4: The constant involuntary urine loss after hysterectomy is therefore a vesicovaginal fistula.
\[\boxed{\text{Vesicovaginal fistula}}\]
Step 2: Test each option against the anatomy left after surgery. The uterus has been taken out, so no vesicouterine fistula can form, eliminating option (c) on logical grounds alone. A urethrovaginal fistula tends to leak only while voiding rather than continuously, so it does not match constant dribbling.
Step 3: That narrows it to a bladder or ureteric injury. The bladder sits directly in front of the cervix and uterus and is the organ most frequently injured at hysterectomy. A direct bladder-to-vagina opening produces ceaseless leakage with no voluntary control, which is exactly the described scenario. A ureterovaginal fistula usually still lets the bladder fill, so intermittent voluntary voiding persists, making it a less complete fit.
Step 4: The constant involuntary urine loss after hysterectomy is therefore a vesicovaginal fistula.
\[\boxed{\text{Vesicovaginal fistula}}\]
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