title: Large Urethro-Vesico-Vaginal Fistula due to a Vaginal Foreign Body in a 22-Year-Old Woman: Case Report and Literature Review.
abstract: In the non-industrialized countries of Africa and Asia obstetric fistulas are more frequently caused by prolonged labour, whereas in countries with developed healthcare systems they are generally the result of complications of gynaecological surgery or, rarely, benign pathologies like inflammation or foreign bodies. A 22-year-old woman was brought to the gynaecology clinic because of foul-smelling vaginal discharge. On pelvic examination a ring-like foreign body was impacted between the anterior and posterior vaginal wall. MRI scan confirmed the presence of a cylindrical foreign body in the vagina and the patient revealed that she had 'involuntarily' inserted a plastic bubble bath cap into the vagina. At surgery removal of the cap was difficult and at the end of the manoeuver evidence of a huge urethro-vesico-vaginal fistula occurred. The patient was discharged with bilateral ureteral stents and suprapubic catheter. After 3 months we performed an end-to-end anastomotic urethroplasty to repair the urethral avulsion and restored the bladder/trigonal and vaginal/cervical defects with 3 layers of sutures; 3 months later the patient had no complaints. Complex genital fistulas represent an extremely debilitating morbidity. In our case, a vaginal approach was successful, but the choice between an abdominal or vaginal approach depends on the surgeon's experience and training.
authors.affiliation: Urology Clinic, University of Verona, Verona, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Curti
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Cerruto
authors.forename: Carmelo
authors.initials: C
authors.lastname: Monaco
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008279:Magnetic Resonance Imaging; D014515:Ureteral Diseases / Q000209:etiology* / Q000601:surgery; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult