Vesicovaginal fistula

Case contributed by Mostafa Mohamed
Diagnosis certain

Presentation

Urinary incontinence with a recent history of total abdominal hysterectomy and bilateral salpingo-oophorectomy, along with a history of double J ureteric stent insertion followed by its removal.

Patient Data

Age: 45 years
Gender: Female
ct
This study is a stack
Axial
non-contrast
This study is a stack
Axial C+
delayed
This study is a stack
Coronal C+
delayed
This study is a stack
Sagittal
C+ delayed
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Info
  • a fistula is seen communicating between the posterior urinary bladder and the upper part of the anterior vaginal wall. Contrast media passes through the vaginal canal

  • mild circumferential, uniform mural thickening of the urinary bladder is noted, with a few internal air loculi. Associated mild smudging of the surrounding fat planes

  • non-orthotopic insertion of both ureters is seen at the anterolateral and superior aspects of the urinary bladder. Associated mild dilatation of the left ureter and left pelvicalyceal system, with no evidence of obstructing stones

Case Discussion

This case illustrates a vesicovaginal fistula resulting from a total abdominal hysterectomy with bilateral salpingo-oophorectomy, leading to urine discharge through the vagina.

The most common causes of vesicovaginal fistula formation are prolonged obstructed labor and surgical procedures such as hysterectomy as in this case. Other risk factors include pelvic malignancies (e.g., bladder or endometrial carcinoma) and radiotherapy.

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