Transvaginal sonographic findings in vesicovaginal fistula

Abstract

With the introduction of transvaginal probes, high resolution images of organs in the pelvis can now be obtained. We present two cases of vesicovaginal fistula with transvaginal sonographic findings. One was secondary to abdominal hysterectomy, the other was a sequela of radiotherapy. CASE REPORT Case 1A 27-year-old woman, G4P3, had an abdominal hysterectomy for symptomatic uterine myoma and developed a watery vaginal discharge on the 21st postoperative day. A methylene blue test was positive, and cystoscopy confirmed a vesicovaginal fistula. Five months later, repeat cystoscopy showed a bladder wall defect, about 0.5 cm in size, located near the orifice of the left ureter.A sonographic scan was performed with a Toshiba SSA-260A scanner (Tokyo, Japan) with a 5.0-MHz vaginal probe. It showed a fistula tract with an echogenic wall, located in the upper vaginal wall ( Figure 1A). The fistula tract was clearly delineated when the upper vagina and bladder were filled with urine. The diameter of the fistula tract diminished in size and the outline became obscure when the vagina and bladder were further distended with a greater amount of urine ( Figure 1B). However, a flow wave from the fistula into the urine of the bladder was inducible by coughing, helping to locate the site of fistula. The mucosa of the bladder wall was 3.2 mm thick. Urinalysis showed a leukocyte count of 8/HPF to 15/HPF. The patient had a Latzko operation and has been well since then.

Bladder Wall Thickness on Ultrasonographic Cystourethrography

“…A decrease in bladder wall thickness may suggest clearing of an infection or inflammation. 13,14 Because an infection may increase bladder wall thickness and may lead to detrusor overactivity, 15 we excluded patients with any evidence of infection or residual urine.…”

Transperineal ultrasonographic diagnosis of vesicovaginal fistula.

“…3 Recently, imaging diagnosis of vesicovaginal and uterovesical fistulas has been reported with transvaginal ultrasonography. 4,5 Our case demonstrates that in the presence of low vesicovaginal fistula the entire fistula tract may be delineated by noninvasive transperineal ultrasonography. This case suggests that in cases of tumor in the lower vagina with symptoms suggestive of urogenital fistula, transperineal ultrasonography should be considered a potential diagnostic tool.…”

Imaging of Iatrogenic Complications of the Urinary Tract

“…Sonography and color Doppler US with a microbubble contrast agent and MRI have also shown to be useful in detection of fistulous tracts. [75][76][77] The right ureter was also dilated (not shown). The left kidney already excretes contrast material.…”