Imaging Diagnosis—urethrovaginal Fistula Caused by a Migrating Grass Awn in the Vagina

Abstract

A young intact female dog was presented with urinary incontinence. Abdominal ultrasound revealed the presence of hyperechoic linear structures within the cranial vagina suggestive of foreign material. A computed tomography (CT) retrograde vaginourethrogram demonstrated the presence of a fistulous tract between the urethra and vagina. A presumptive diagnosis of urethrovaginal fistula due to migration of foreign material was made. The grass awn was removed with vaginoscopic-guided retrieval. Fourteen days later, surgical repair of the fistula and an ovariohysterectomy were done. This case report emphasizes the usefulness of CT for diagnosis and precise anatomical localization of genitourinary tract fistulas.

Prostatic Localization of a Migrating Grass Awn Foreign Body in a Dog

“…Vegetal foreign bodies can penetrate through intact skin or natural orifices (external ear canal, nasal sinuses or oral cavity) and subsequently migrate into the body [ 1 , 2 , 3 , 4 , 5 , 6 ]. Migration of the grass awns through the genitourinary tract (urethra, urinary bladder or vagina) has been reported in dogs: an ascending migration through the vagina/urethra or a penetration pathway through the skin/intestinal tract has been suspected [ 7 , 8 , 9 ]. In this case report, the grass awn was visualized by ultrasonography in the right prostatic lobe with the tip localized close to the capsule of the prostate and the barbs near the prostatic urethra.…”

“…The most common localizations of vegetal foreign bodies are the external ear canal, nasal cavity, interdigital spaces, conjunctiva, thoracic cavity or iliopsoas muscles [ 1 , 2 , 3 , 4 , 5 , 6 ]. Rarely, grass awns can migrate through the genitourinary tract and localize in the urethra, urinary bladder or vagina [ 2 , 7 , 8 , 9 ].…”

Urogenital anomalies and urinary incontinence in an English Cocker Spaniel dog with XX sex reversal

“…20,21 A urethrovaginal communication also can occur as a sequela of surgery, trauma, or the presence of a foreign body. 22 Differentiation between congenital and acquired urethrovaginal communications requires careful history taking and identification of chronic inflammation, foreign bodies, and the location and morphology of the fistula via imaging modalities such as ultrasonography, retrograde urethrography, CT, vaginoscopy, and urethrocystoscopy. 22 In particular, urethrocystoscopy and vaginoscopy provide excellent visualization for identification of lower urinary tract disease.…”

“…22 Differentiation between congenital and acquired urethrovaginal communications requires careful history taking and identification of chronic inflammation, foreign bodies, and the location and morphology of the fistula via imaging modalities such as ultrasonography, retrograde urethrography, CT, vaginoscopy, and urethrocystoscopy. 22 In particular, urethrocystoscopy and vaginoscopy provide excellent visualization for identification of lower urinary tract disease. 15,23 Although urethrocystoscopy and vaginoscopy were not performed in this dog, the studies performed provided adequate information about urinary incontinence and the congenital anomalies present.…”

An uncommon localisation of a vegetal foreign body in a dog: a case report

“…Grass awns are most frequently found in the external ear canal, subcutaneous tissue, interdigital space, conjunctiva, and nasal and oral cavities, but they can also reach the thoracic or abdominal cavities or sublumbar musculature by penetrating the body wall, ingestion, or inhalation and subsequent migration (Schultz and Zwingenberger 2008;Cherbinsky et al 2010;Caivano et al 2014;Vansteenkiste et al 2014). Grass awns have also been detected in the vagina (Agut et al 2016), eyelid (Marchegiani et attenuation in air-containing structures, as elongated gas-containing foci in soft tissues or as slightly hyperattenuating foci with soft tissue (Schultz and Zwingenberger 2008;Vansteenkiste et al 2014). When the foreign body cannot be directly visualised, computed tomography enables estimation of the exact position of the foreign body based on tissue abnormalities like cavitary lesions, tracts and pulmonary consolidation or tissue inflammation (Schultz and Zwingenberger 2008;Vansteenkiste et al 2014).…”