Presentation
History of Wertheim surgery for uterine cervix malignancy three months before, progressive urinary incontinence, and complete urine drainage from the vagina.
Patient Data
Mild delayed secretion and hydroureteronephrosis are visible on the right side. The excreted contrast reaches a structure in the pelvis that lacks the bladder and urethra's normal shape. The contrast freely goes outside to the perineum from it. On delayed images about 1 hour after contrast injection, another structure anterior to the above-mentioned becomes visible as minimal contrast surrounds the Foley bubble. The structure that fills in early images and depletes freely is the vagina; the anterior one that is barely visible on delayed images is the bladder. Findings favor iatrogenic bilateral ureteral injury and uterovaginal fistula formation.
The yellow line and the yellow dots outline the vagina and the bladder, respectively. The pink arrow points to the foley catheter bubble. The white dots depict the fistula tract between the distal right ureter and the vagina.
Case Discussion
The delayed bladder visualization could be due to a vesicovaginal fistula or partial ureteral injury. The urologist inserts a foley catheter the day before the IVP. Still, there was no urine output from the catheter, which against partial ureteral damage, and favors the former possibility.
The patient underwent bilateral ureteral re-implantation. The exploration of the vesicovaginal fistula was not reasonably possible because of extensive adhesion and disrupted anatomy. But when the urologist opens the bladder, he did not find an obvious fistula orifice.