Editing Functional: Urinary Fistulae (section)

===== Recommended =====
* '''History and Physical Exam'''
** '''History'''
*** '''<span style="color:#ff0000">Most common complaint is constant urinary drainage per vagina</span>'''
**** The amount of urinary leakage can vary considerably from patient to patient and may be proportional to the size of the fistula tract.
*** '''Pain is uncommon'''
** '''Physical exam'''
*** '''A pelvic examination with a speculum should always be performed'''.
**** '''VVFs after hysterectomy are most commonly located along the anterior vaginal wall at the level of the vaginal cuff'''
*** '''<span style="color:#ff0000">Visual and manual assessment of inflammation surrounding the fistula is necessary,</span>''' because it may affect timing of the repair. 
****Significant inflammation, infection, or induration around the fistula may mitigate against immediate repair.

* '''Laboratory'''
** '''<span style="color:#ff0000">Urinalysis +/- culture, when indicated</span>'''
**Cytology, when indicated

* '''Imaging'''
** '''<span style="color:#ff0000">Lower tract imaging (with cystogram and/or voiding cystourethrogram (VCUG))</span>'''
*** '''A cystogram that fails to demonstrate a suspected VVF but lacks voiding images or postvoid images should be considered non-diagnostic.'''
** '''<span style="color:#ff0000">Upper tract imaging (with CT urography)</span>'''
***'''Up to 12% of postsurgical VVFs have an associated ureteral injury or ureterovaginal fistula'''

* '''Other'''
** '''<span style="color:#ff0000">Cystoscopy</span>'''
*** '''<span style="color:#ff0000">Should be performed in patients for whom a suspicion of VVF is present</span>'''