title: Delayed presentation and successful repair of a recurrent vesicovaginal fistula after hysterectomy and primary abdominal repair.
abstract: Urogenital fistulae are an uncommon consequence of gynecologic surgery. Vesicovaginal fistulae due to gynecologic surgery generally appear 1-6 weeks after surgery and recurrent fistulae within 3 months of their repair. The pathogenesis of vesicovaginal fistula formation remains unclear. We present the case of a 36-year-old woman with a spontaneously recurring vesicovaginal fistula 21 months after abdominal repair of a vesicovaginal fistula caused by a laparoscopic-assisted vaginal hysterectomy. During the repair of the fistula and excision of the vaginal cuff, two small fluid-filled cysts between the bladder mucosa and the vaginal epithelium were encountered. Vesicovaginal fistulae can occur spontaneously and remote from surgery. The finding of small fluid-filled cysts in the cuff suggests that rupture of a similar cyst may have led to the formation of the fistula.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA. flynn001@mc.duke.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Flynn
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
mesh_terms: D000328:Adult; D003560:Cysts; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications; D012008:Recurrence; D012421:Rupture; D013997:Time Factors; D014621:Vagina / Q000473:pathology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000473:pathology / Q000601:surgery*