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Vesicovaginal Fistula

  • R. Scott Taylor , Megan Wasson und John V. Ashurst
Veröffentlicht/Copyright: 1. Dezember 2017
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Journal of Osteopathic Medicine
Aus der Zeitschrift Journal of Osteopathic Medicine Band 117 Heft 12

Keywords: hysterectomy; obstetrics and gynecology; vesicovaginal fistula

A 42-year-old woman presented to the emergency department with urinary incontinence. She underwent a total hysterectomy 18 days prior, during which an intraoperative bladder injury occurred and was repaired. The patient reported incontinence despite having a urethral Foley catheter placed during the surgical procedure. Pelvic examination revealed a thin yellow liquid in the vaginal vault. Computed tomographic cystographic images revealed a vesicovaginal fistula with contrast tracking posteriorly into the vaginal vault (images A and B, arrows). Conservative treatment with a Foley catheter and repeated cystoscopy 2 weeks later was recommended. Because her symptoms did not improve, ureteral reimplantation was performed using a modified O'Connor technique, which resulted in resolution of the symptoms.

Vesicovaginal fistula (VVF) is a passage that connects the bladder to the vagina and allows discharge of urine into the vaginal vault.1 The most common cause of VVF worldwide is prolonged obstructed labor.1 In industrialized cultures, however, it is associated with iatrogenic bladder injury, most notably during gynecologic procedures.1 Approximately 0.8 of 1000 hysterectomies are complicated by a VVF.1 In cases of small VVFs, conservative treatment can be used.1,2 Surgical intervention via a transvesical or extravesical approach has been successful when conservative treatment fails.3

From the Department of Emergency Medicine at the Duke Lifepoint Conemaugh Memorial Medical Center in Johnstown, Pennsylvania (Drs Taylor and Ashurst) and the Department of Gynecology at the Mayo Clinic in Phoenix, Arizona (Dr Wasson).
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to John V. Ashurst, DO, MSc, Department of Emergency Medicine, Duke Lifepoint Conemaugh Memorial Medical Center, 1086 Franklin St, Johnstown, PA 15905-4305. E-mail:

References

1. Bodner-Adler B , HanzalE, PablikE, KoelblH, BodnerK. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: a systematic review and meta-analysis. PLoS One. 2017;12(2):e0171554. doi:10.1371/journal.pone.0171554Suche in Google Scholar PubMed PubMed Central

2. Bazi T . Spontaneous closure of vesicovaginal fistula after bladder drainage alone: review of the evidence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(3):329-333. doi:10.1007/s00192-006-0194-7Suche in Google Scholar PubMed

3. Miklos JR , MooreRD, ChinthakananO. Laparoscopic and robotic assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol. 2015;22(5):727-736. doi:10.1016/j.jmig.2015.03.001Suche in Google Scholar PubMed

Received: 2017-04-10
Accepted: 2017-04-11
Published Online: 2017-12-01
Published in Print: 2017-12-01

© 2017 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2017.154
Schlagwörter für diesen Artikel
hysterectomy; obstetrics and gynecology; vesicovaginal fistula
Creative Commons
BY-NC-ND 4.0

Artikel in diesem Heft

  1. SURF
  2. Challenging Case of Parotitis: A Comprehensive Approach
  3. OMT MINUTE
  4. OMT for Patients With Multiple Sclerosis
  5. IN MY VIEW
  6. Defining Osteopathic Continuing Medical Education
  7. LETTERS TO THE EDITOR
  8. Landmark Article Transforms Traditional View of the Autonomic Nervous System
  9. ORIGINAL CONTRIBUTION
  10. Measuring Adherence and Outcomes in the Treatment of Patients With Multiple Sclerosis
  11. BRIEF REPORT
  12. Musculoskeletal Disorders in Ophthalmologists After Simulated Cataract Operation: A Pilot Study
  13. REVIEW
  14. Benign Breast Conditions
  15. Role of Antiplatelet Therapy in Stroke Prevention in Patients With Atrial Fibrillation
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Predictors of Osteopathic Medical Students’ Readiness to Use Health Information Technology
  18. CASE REPORT
  19. Osteopathic Manipulative Treatment for the Management of Adjacent Segment Pathology
  20. Inguinal Herniation of Perinephric Tissue: Case Report and Review of the Literature
  21. CLINICAL IMAGES
  22. Vesicovaginal Fistula
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