What is the most likely diagnosis for a patient with urinary incontinence and vaginal discharge after a forceps delivery?

What is the most likely diagnosis for a patient with urinary incontinence and vaginal discharge after a forceps delivery?

• A. Urinary tract infection
• B. Pelvic organ prolapse
• C. Cystovaginal fistula
• D. Vaginal laceration

Answer: (C)

In the context of a patient presenting with urinary incontinence and vaginal discharge following a forceps delivery, cystovaginal fistula is the most likely diagnosis due to the combination of symptoms and the circumstances of the delivery. A cystovaginal fistula is an abnormal connection between the bladder and the vagina, which can lead to continuous leakage of urine into the vaginal canal. This often occurs after traumatic deliveries, particularly those involving forceps, which can cause injury to the pelvic structures. The presence of vaginal discharge alongside urinary incontinence can suggest the passage of urine through the vaginal canal, characteristic of a cystovaginal fistula. The trauma inflicted during a forceps delivery can disrupt normal anatomical boundaries, increasing the risk of such an injury. While urinary tract infections can cause urinary incontinence, they typically do not present with vaginal discharge, making this less likely in this scenario. Pelvic organ prolapse may lead to urinary symptoms, but it is less commonly associated with vaginal discharge unless there is significant vaginal wall involvement or infection. Vaginal lacerations, although they occur during delivery, would present more acutely with pain and bleeding rather than primarily urinary incontinence and discharge, which further supports cystovaginal fistula as the more fitting diagnosis

In the context of a patient presenting with urinary incontinence and vaginal discharge following a forceps delivery, cystovaginal fistula is the most likely diagnosis due to the combination of symptoms and the circumstances of the delivery. A cystovaginal fistula is an abnormal connection between the bladder and the vagina, which can lead to continuous leakage of urine into the vaginal canal. This often occurs after traumatic deliveries, particularly those involving forceps, which can cause injury to the pelvic structures.

The presence of vaginal discharge alongside urinary incontinence can suggest the passage of urine through the vaginal canal, characteristic of a cystovaginal fistula. The trauma inflicted during a forceps delivery can disrupt normal anatomical boundaries, increasing the risk of such an injury.

While urinary tract infections can cause urinary incontinence, they typically do not present with vaginal discharge, making this less likely in this scenario. Pelvic organ prolapse may lead to urinary symptoms, but it is less commonly associated with vaginal discharge unless there is significant vaginal wall involvement or infection. Vaginal lacerations, although they occur during delivery, would present more acutely with pain and bleeding rather than primarily urinary incontinence and discharge, which further supports cystovaginal fistula as the more fitting diagnosis