Presentation
Recent history of total abdominal hysterectomy and bilateral salpingo-oophorectomy, and discharge of urine through the vagina.
Patient Data
By injecting contrast medium through a suprapubic catheter, a small urinary bladder is visualized, complicated by a vesicovaginal fistulous formation and the contrast media passes into the vaginal canal.
Left-sided vesicoureteral reflux is also seen.
The uterus and ovaries are not seen at the anatomical location due to prior resection.
The air-fluid level is present within the urinary bladder. After IV contrast media administration, on delayed CT cystogram images, a vesicovaginal fistula is observed in the left posterior aspect and the contrast media passes into the vaginal canal.
Case Discussion
This case demonstrates a vesicovaginal fistula due to a total abdominal hysterectomy and bilateral salpingo-oophorectomy, resulting in an involuntary discharge of urine through the vagina.
A prolonged obstructed labor and surgery, e.g. hysterectomy, are the most common causes for a vesicovaginal fistulous formation. However, pelvic malignancy (e.g. bladder carcinoma, endometrial carcinoma), radiotherapy, uterine rupture, trauma, pelvic inflammatory disease and diabetes are the other risk factors.
A fluoroscopic cystogram is a commonly used method for evaluating vesicovaginal fistula. Contrast is injected into the bladder through a Foley or suprapubic catheter, and the fistulous tract is outlined. The tract may also be visible if a CT cystogram is performed, and CT usually provides more details.
Unable to process the form. Check for errors and try again.