Large Urethro-Vesico-Vaginal Fistula due to a Vaginal Foreign Body in a 22-Year-Old Woman: Case Report and Literature Review

Abstract

In the non-industrialized countries of Africa and Asia obstetric fistulas are more frequently caused by prolonged labour, whereas in countries with developed healthcare systems they are generally the result of complications of gynaecological surgery or, rarely, benign pathologies like inflammation or foreign bodies. A 22-year-old woman was brought to the gynaecology clinic because of foul-smelling vaginal discharge. On pelvic examination a ring-like foreign body was impacted between the anterior and posterior vaginal wall. MRI scan confirmed the presence of a cylindrical foreign body in the vagina and the patient revealed that she had ‘involuntarily' inserted a plastic bubble bath cap into the vagina. At surgery removal of the cap was difficult and at the end of the manoeuver evidence of a huge urethro-vesico-vaginal fistula occurred. The patient was discharged with bilateral ureteral stents and suprapubic catheter. After 3 months we performed an end-to-end anastomotic urethroplasty to repair the urethral avulsion and restored the bladder/trigonal and vaginal/cervical defects with 3 layers of sutures; 3 months later the patient had no complaints. Complex genital fistulas represent an extremely debilitating morbidity. In our case, a vaginal approach was successful, but the choice between an abdominal or vaginal approach depends on the surgeon's experience and training.

Urethrovaginal fistula following vaginal prolapse of a pedunculated uterine myoma: a case report

“…Fistulas involving the urethra are rare and are observed usually with an intravaginal foreign body [ 1 , 2 ] or gynecologic surgery [ 3 ]. The foreign body compresses the vaginal and urethral walls, leading to ischemia and sloughing of vaginal and urethral tissue with fistula formation as the consequence.…”

“…These fistulas are secondary to bladder or rectal ischemia secondary to compression of these organs by the fetal presenting part, followed by necrosis and sloughing of the ischemic tissue, thereby, creating a communication between the vagina and the bladder or the rectum. Urethrovaginal fistula is another entity that is usually secondary to a vaginal foreign body [ 1 , 2 ] or to gynecologic surgery [ 3 ]. No case of urethrovaginal fistula due to delivered myoma has been published.…”

Urethrovaginal Fistula Following Vaginal Prolapse of a Pedunculated Uterine Myoma: A Case Report

“…Fistulas involving the urethra are rare and are observed usually with an intravaginal foreign body [1,2] or gynecologic surgery [3]. The foreign body compresses the vaginal and urethral walls, leading to ischemia and sloughing of vaginal and urethral tissue with fistula formation as the consequence.…”

“…The foreign body compresses the vaginal and urethral walls, leading to ischemia and sloughing of vaginal and urethral tissue with fistula formation as the consequence. This has been observed in women with a hard-plastic intravaginal foreign body [1,2]. Moreover, during gynecologic surgery, the urethra can be traumatized with a needle, a surgical blade, or another instrument [3].…”

“…These fistulas are secondary to bladder or rectal ischemia secondary to compression of these organs by the fetal presenting part, followed by necrosis and sloughing of the ischemic tissue, thereby, creating a communication between the vagina and the bladder or the rectum. Urethrovaginal fistula is another entity that is usually secondary to a vaginal foreign body [1,2] or to gynecologic surgery [3]. No case of urethrovaginal fistula due to delivered myoma has been published.…”