Vaginography for Demonstration of Ureterovaginal, Vesicovaginal, and Rectovaginal Fistulas, with Case Reports

Publisher Website
Google Scholar
Abstract
Because of its proximity to the ureters, bladder, and rectum, the vagina is involved frequently in fistulous communication with other organs. Despite this fact, very few references to the roentgenologic examination of the vagina can be found in the medical literature. Two papers do appear. Van Meensel (1) and Papez et al. (2), utilizing opaque medium, examined the vagina in terms of length, width, tonicity, and mucosal detail in health and in diseased conditions. Van Meensel includes an illustration of a fistula following hysterectomy but does not discuss this. The author, however, has been able to find no reference to the utilization of the vagina for the express purpose of demonstrating fistulas,3 although he has employed this method on several occasions over the last ten years, each time successfully. Three well-known types of fistula, ureterovaginal, vesicovaginal, and rectovaginal, are presented in terms of their demonstration by a procedure which has been entitled “vaginography.” The technic employed is described. Technic The perineum and vagina are cleansed (we have used pHisoHex) and examination is carried out with sterile preparation. A Foley catheter, with a 30-c.c. balloon attached, is inserted into the vagina. From between 10 and 30 c.c. of air or water is inserted into the long neck of the balloon, and the neck is clamped. The degree of distention of the balloon required for a snug fit varies and depends primarily upon the distensibility of the vagina and introitus and the intactness of the perineal floor. The catheter is gently but firmly tugged to determine if it lies securely, the amount of air or water in the balloon being altered, if necessary, until it does. The patient is then placed supine on the table, with lower extremities in adduction. A 50-c.c. syringe containing 20 to 50 per cent Hypaque is connected to the catheter via an adapter, and under fluoroscopic control injection is started. Possible leakage about the balloon can be prevented (required on one occasion) by maintaining slight traction upon it during the remainder of the examination. Injection must be slow, as it is vital that the sequence of events (filling of structures) be visualized. The patient is examined in supine, both posterior oblique, and lateral positions. The lateral position is vital for antero-posteriorly directed fistulas (rectovaginal and vesicovaginal). Spot-films are obtained during active injection. Anteroposterior and lateral postfluoroscopic roentgenograms are secured (preferably with reinjection) as are other views, as may be indicated on the basis of fluoroscopic impression. Opaque material remaining in the vagina (if present) may be removed via syringe, and air may be injected in order to produce a double-contrast study. Case Reports Case I: P. G., a 25-year-old Caucasian woman, was admitted April 30,1962, to the Bernalillo County-Indian Hospital with a history of vaginal spotting and postcoital bleeding.

This publication has 0 references indexed in Scilit: