title: Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina.
abstract: BACKGROUND
  Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.
  
  
  OBJECTIVE
  The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.
  
  
  METHODS
  A case is presented. A comprehensive review of the literature was performed (1948-2013).
  
  
  RESULTS
  A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal.
  
  
  CONCLUSIONS
  This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.
authors.affiliation: Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
authors.forename: James Fergus
authors.initials: JF
authors.lastname: Donaldson
authors.forename: Campbell
authors.initials: C
authors.lastname: Tait
authors.forename: Marcel
authors.initials: M
authors.lastname: Rad
authors.forename: Shonagh
authors.initials: S
authors.lastname: Walker
authors.forename: Thomas B L
authors.initials: TB
authors.lastname: Lam
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abdel-Fattah
authors.forename: Satchi Kuchibhotla
authors.initials: SK
authors.lastname: Swami
mesh_terms: D000328:Adult; D003558:Cystoscopy / Q000379:methods; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D012008:Recurrence; D012092:Replantation / Q000379:methods; D014513:Ureter / Q000473:pathology; D014522:Urethral Diseases / Q000209:etiology*; D014547:Urinary Diversion / Q000379:methods; D014548:Urinary Fistula / Q000209:etiology* / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000601:surgery
keywords: Acute Kidney Injury; Foreign Bodies; Renal Insufficiency; Sex Toy; Urinary Fistula; Vaginal Fistula; Vesicovaginal Fistula