Evaluation of Ureteric Fistula with Ultrasonography and Dye Test in a Low-resource Setting

Abstract

Introduction: Ureteric injury is a possible complication of pelvic surgery. Ultrasonography, when combined with dye test is relatively inexpensive for evaluation of patients with ureteric fistula. The aim of this paper was to determine the role of ultrasonography and dye test in the evaluation of patients with ureteric fistula in a low-resource setting. Methods: This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria between January 2014 and December 2016. Thirty-two patients had repair of ureteric fistula during the study period, but fourteen met the inclusion criteria. Patients that had preoperative evaluation with pelvic ultrasonography and dye test were included in this study. Results: Their mean age was 37.6±6 years. Eleven (78.57%) of the patients had ureteric fistula from emergency caesarean section, while 3(21.43%) had fistula from abdominal hysterectomy. Eleven patients (78.57%) had hydronephrosis during ultrasonography. Out of the 11 patients with hydronephrosis, it was bilateral in 5 (45.45%). Out of the 14 patients, 6 (42.86%) had hydroureter during ultrasonography. In all eleven patients, dye test was negative despite presence of urine in the vagina which was strongly suggestive of ureteric fistula. Conclusion: Common features of ultrasonography in patients with ureteric fistula are hydronephrosis and hydroureter. However, these features are not pathognomonic for ureteric fistula. Combinations of ultrasonography and dye test are useful and cheap methods for evaluating patients with ureteric fistula.