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Vesicovaginal fistula

Case contributed by Dr Ian Bickle

Presentation

Hysterectomy for grade 1 cervical malignancy 6 months earlier. Persistent vaginal discharge of clear fluid.

Patient Data

Age: 40 years
Gender: Female
CT

The collecting systems and ureters are normal.

Contrast in both the urinary bladder and vagina.

Thin track in the left paramidline outling with contrast connecting the posterior bladder wall and upper vagina.

Annotated image

The red arrows indicate the thin fistulous track from the posterior wall of the bladder into the upper vagina.

Case Discussion

Excretory phase CT ( CT-IVU ) illustrated excellently a fistulous tract between the vagina and bladder in keeping with a vesicovaginal fistula.

In this case this is likely to be post operative/iatrogenic in nature, given the low stage pelvic malignancy prior to hysterectomy.

In many cases CT has replaced traditional fluroscopic studies in illustrating genitourinary tract fistulas.

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