Obstetric fistula: Evaluation with ultrasonography

Twenty-two patients with 24 fistulae were examined prospectively with real- time sonography. Sonographic were compared with those of intravenous urogra ms and correlated with the findings at examination under anesthesia and at surgery. Various genital abnormalities not revealed by intravenous urograph y were demonstrated by sonography preoperatively. These included cervical i njuries, vesicovaginal fistula showing "flat tire" sign and hourglass defor mities, and identification of the site, size, and course of fistulae in sev en (29%) of the cases. However, the demonstration of the fistulae by sonogr aphy is poor relative to that of examination under anesthesia, in which 21 (87%) of the fistulae were identified. The factors responsible for the diff iculty in demonstrating the fistulae on sonography, which included size and multiplicity, are discussed. Sonography is complementary to examination un der anesthesia in preoperative evaluation of the patients with obstetric fi stulae in general and in those with previous unsuccessful repairs in partic ular.