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Clinical Case Discussion

Case Presentation: Vesicovaginal Fistula Following a Total Abdominal Hysterectomy

By: Richard Inman

EU Focus, Volume 2 Issue 1, April 2016

Published online: 01 April 2016

Abstract Full Text Full Text PDF (379 KB)

A 43-yr-old woman underwent a total abdominal hysterectomy for benign disease. The procedure appeared to be straightforward, although heavy bleeding around the left ovarian vascular pedicle was encountered. This needed additional sutures for control. Postoperatively the patient developed left loin pain and was found to have new-onset left-sided hydronephrosis on an abdominal ultrasound scan. A percutaneous nephrostomy was inserted into the left kidney and renal pelvis, and 2 d later this was followed by percutaneous antegrade ureteric stenting.

The patient then developed continuous urinary leakage per vagina despite a period of catheterisation. A vesicovaginal fistula was diagnosed and she was referred to our specialist centre for repair. We performed a cystogram (Fig. 1) and upper tract imaging via a computed tomography urogram. We then performed an examination under anaesthesia, including cystoscopy with bilateral retrograde studies (Fig. 2).

gr1

Fig. 1 Cystogram showing a vesicovaginal fistula.

gr2

Fig. 2 (A) Endoscopic image of the bilateral ureteric catheters. Note that the fistula is just about visible beyond the trigone (black arrow). (B) Endoscopic image of the fistula.

Conflicts of interest

The author has nothing to disclose.

Footnotes

Department of Urology, Royal Hallamshire Hospital, Sheffield, UK

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