Evaluating menouria-comparison of X-ray cystography and hysterography

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Objective: To compare the diagnostic accuracy of X-Ray cystography with hysterography in the evaluation of menouria. DESIGN: Descriptive study.
Duration and setting: Department of Radiology Civil Hospital Karachi (CHK) from January 1996 to April 2007.
Patients and methods: Adult female patients with complaint of menouria were included. Those with non-cyclical hematuria or associated urinary or fecal incontinence were excluded. Patients’ demographics, history and physical examination findings were noted. Transabdominal ultrasound of pelvis was done in all cases. Cystography and hysterography were conducted in every case under fluoroscopic control. Radiographic findings were compared against surgical findings. Results were expressed in percentages and means.
Results: Over the 11 years of study period, 12 cases of menouria were encountered. All were secondary to obstetric causes with an age range of 19-25 years and average duration of symptoms as 12 months. Hysterography identified a vesico-uterine fistula in 11/12 (91.66%), cystography in 02 (16.66%) and trans-abdominal ultrasound in 03 (25%). Examination under anesthesia and surgery corresponded with the site and number of fistula in 11 out of 12 cases while detecting a fistula in one case that was not seen on imaging due to the presence of granulation tissue.
Conclusion: In this small series hysterography was better than either cystography or transabdominal ultrasound in the diagnosis of menouria due to vesico-uterine fistula. Presence of granulation tissue is a possible source of false negative results on pre-operative radiography.


Journal of the Liaquat University of Medical and Health Sciences