Presentation
Poor urinary stream. Passive dribbling of urine after micturition
Patient Data
Control radiograph shows no calcification along the urinary tract. The full bladder film shows normal urinary bladder outline with no evidence of vesico-ureteric reflux or diverticulum. In the micturating film, there is a fistulous communication between distal third of urethra with the vagina, which is seen as a oblong blind ended contrast filled structure posterior to the bladder and urethra. A little contrast was seen visibly coming out from the vaginal opening.
Case Discussion
Congenital urethrovaginal fistula is an extremely rare entity which is part of the urogenital sinus abnormalities. As such, it is known to be associated with other genitourinary malformations including renal agenesis, uterine agenesis and cloaca malformations.
Usual presentation is poor urinary stream and dribbling of urine. Urinary tract infection and pain may be other presentations. Few case have presented as late as 25 years of age.
Micturating cysto urethrography reveals the fistulous communication and the contrast filled vagina is seen as a oblong pouch posterior to the urinary bladder and urethra. MRI of abdomen and pelvis should accompany MCU to exclude other urogenital malformations.