Double dye test is useful for diagnosing vesicovaginal

Vesicovaginal fistula

Vesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault....

 or ureterovaginal fistula

Fistula

In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...

e. For this test, the patient takes oral phenazopyridine

Phenazopyridine

Phenazopyridine is a chemical which, when excreted into the urine, has a local analgesic effect. It is often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections, surgery, or injury to the urinary tract...

 (Pyridium) 200 mg TDS

TDS

TDS may refer to:* to be taken three times daily; from Latin, ter die sumendus* Total dissolved solids, the total mass content of dissolved ions and molecules or suspended microgranules in a liquid medium...

, and indigo carmine

Indigo carmine

Indigo carmine, or 5,5'-indigodisulfonic acid sodium salt, also known as indigotine or FD&C Blue #2 is a pH indicator with the chemical formula C16H8N2Na2O8S2. It is approved for use as a food colorant in the USA and the EU and has the E number E132.-Uses:The primary use of Indigo carmine is as a...

 or methylene blue

Methylene blue

Methylene blue is a heterocyclic aromatic chemical compound with the molecular formula C16H18N3SCl. It has many uses in a range of different fields, such as biology and chemistry. At room temperature it appears as a solid, odorless, dark green powder, that yields a blue solution when dissolved in...

 is filled in to the empty urinary bladder

Urinary bladder

The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

 via a urethral catheter

Catheter

In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

. Pyridium turns urine orange in the kidneys, and methylene blue (or indigo carmine) turns urine blue in the bladder.

A tampon

Tampon

A tampon is a mass of cotton or rayon or a mixture of the two inserted into a body cavity or wound to absorb bodilyfluid. The most common type in daily use is designed to be inserted into the vagina during menstruation to absorb the flow of menstrual fluid...

 is placed into the vagina

Vagina

The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...

. If the tampon turns blue, vesicovaginal fistula is suspected. If the tampon turns orange, ureterovaginal fistula is suspected. If the tampon turns blue and orange, suspect a combination of vesicovaginal and ureterovaginal fistulae. It is important to be alert for leakage around the catheter, which may spill back into the vagina creating the false impression of a fistula. It is also important to ensure that adequate distension of the bladder occurs as some fistulae do not leak at small volumes; conversely, some fistulae with an oblique track through the bladder wall may leak at small volumes, but not at capacity. Direct inspection of leaking dye in vagina in lithotomy position

Lithotomy position

The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations...

 is better than the traditional 'three swab test' as multiple fistulae may be located in this way.

See also

• Obstetric fistula
  Obstetric fistula
  Obstetric fistula is a severe medical condition in which a fistula develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.-Symptoms and signs:The resulting disorders typically include...
  
  
• Rectovaginal fistula
  Rectovaginal fistula
  A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the...
  
  
• Colposcopy
  Colposcopy
  Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
  
  
• Urinary incontinence
  Urinary incontinence
  Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
  
  

External links

• Vaginal fistula from Mayo Clinic
  Mayo Clinic
  Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...