Int Urogynecol J DOI 10.1007/s00192-015-2672-2
IMAGES IN UROGYNECOLOGY
Chronic vaginal discharge due to vesicovaginal fistula Tae-Hee Kim & Hae-Hyeog Lee & Jun-Mo Kim
Received: 23 January 2015 / Accepted: 24 February 2015 # The International Urogynecological Association 2015
Keywords Cystoscopy . Hysterectomy . X-ray computed tomography . Vesicovaginal fistula Abbreviation TAH Total abdominal hysterectomy VVF Vesicovaginal fistula
We would like to report an additional case of a supratrigonal vesicovaginal fistula (VVF) characterized by long-term misdiagnosis, ultimately resolved through the use of computed tomography (CT) and cystoscopy. A 42-year-old woman presented with a case of dysuria and chronic vaginal discharge, which had begun 6 years previously, following a routine total abdominal hysterectomy (TAH) performed to treat a myoma. The patient had frequently sought treatment at a variety of local clinics, with her symptoms generally diagnosed as either chronic cystitis and vaginitis or pelvic inflammatory disease, despite the absence of abnormal urine or vaginal cultures. Following referral to our hospital, we performed a pelvic examination, revealing a whitish vaginal discharge emanating from an area deep in the upper vagina. Cystoscopy of the affected area revealed the presence of a chronic foreign
material in the bladder (Fig. 1). These findings were confirmed by CT, revealing a metallic substance lodged within the bladder. We examined the patient and repaired the vagina in the lithotomy position under general anesthesia. First, we inserted a guidewire into the pinpoint fistula in the upper vagina and into the bladder, with the assistance of cystoscopy (Fig. 2). We removed the foreign body from the bladder by cystoscopy with grasping forceps. The histopathology revealed that the foreign body was non-absorbable suture material. Upon removal of the object, we performed vaginal repair of the VVF in a manner similar to that of Rajamaheswari et al. [1]. The metallic foreign body removed from this patient is thought to have been left behind following TAH, ultimately penetrating the bladder owing to the nature of the substance.
T.
IMAGES IN UROGYNECOLOGY
Chronic vaginal discharge due to vesicovaginal fistula Tae-Hee Kim & Hae-Hyeog Lee & Jun-Mo Kim
Received: 23 January 2015 / Accepted: 24 February 2015 # The International Urogynecological Association 2015
Keywords Cystoscopy . Hysterectomy . X-ray computed tomography . Vesicovaginal fistula Abbreviation TAH Total abdominal hysterectomy VVF Vesicovaginal fistula
We would like to report an additional case of a supratrigonal vesicovaginal fistula (VVF) characterized by long-term misdiagnosis, ultimately resolved through the use of computed tomography (CT) and cystoscopy. A 42-year-old woman presented with a case of dysuria and chronic vaginal discharge, which had begun 6 years previously, following a routine total abdominal hysterectomy (TAH) performed to treat a myoma. The patient had frequently sought treatment at a variety of local clinics, with her symptoms generally diagnosed as either chronic cystitis and vaginitis or pelvic inflammatory disease, despite the absence of abnormal urine or vaginal cultures. Following referral to our hospital, we performed a pelvic examination, revealing a whitish vaginal discharge emanating from an area deep in the upper vagina. Cystoscopy of the affected area revealed the presence of a chronic foreign
material in the bladder (Fig. 1). These findings were confirmed by CT, revealing a metallic substance lodged within the bladder. We examined the patient and repaired the vagina in the lithotomy position under general anesthesia. First, we inserted a guidewire into the pinpoint fistula in the upper vagina and into the bladder, with the assistance of cystoscopy (Fig. 2). We removed the foreign body from the bladder by cystoscopy with grasping forceps. The histopathology revealed that the foreign body was non-absorbable suture material. Upon removal of the object, we performed vaginal repair of the VVF in a manner similar to that of Rajamaheswari et al. [1]. The metallic foreign body removed from this patient is thought to have been left behind following TAH, ultimately penetrating the bladder owing to the nature of the substance.
T.
