Vesicovaginal fistula resulting from a well-cared-for pessary

Abstract

An 84-year-old vaginally grand multiparous woman presented with a vesicovaginal fistula (VVF) after appropriate use of a Gehrung pessary for the past 12 years for stage III pelvic organ prolapse. The patient reported strict adherence to removing her pessary nightly and replacing it in the morning for the last 12 years. One morning, she awoke and noted a sudden gush of urine through the vagina followed by continuous leakage. Given the complex nature of VVF repair with concurrent stage III pelvic organ prolapse, the patient was referred to urogynecologic care. A Latzko fistula repair and LeFort colpocleisis were performed without complication. The patient recovered well with complete resolution of her pelvic organ prolapse and VVF based on negative cystogram findings at 3 weeks postoperatively. At 12 weeks postoperatively the patient denied any urine leakage or pelvic organ prolapse.

Successful Case of Conservative Treatment of Vesicovaginal Fistula by Hodge Pessary Insertion

“…Until now, 11 cases with VVF caused by vaginal pessary were reported in the literature . VVF caused by vaginal pessary was successfully managed by using the Latzko partial colpocleisis technique in some cases .…”

Vaginal Approach to Vesicovaginal Fistula and Vaginal Vault Prolapse Preserving Sexual Function by Latzko Repair and Sacrospinous Suspension

“…There are reports of concomitant prolapse and fistula repair by performing a Latzko procedure and LeForte colpocleisis [2, 3]. Although this is a simple and effective option for women who are not sexually active, there is little in the literature to guide surgeons in the case of a woman who is sexually active and has a VVF and prolapse.…”

“…Its occurrence with complete vaginal vault eversion is even less common. Information about different operative approaches is limited to recommendations for colpocleisis [2, 3] which would not preserve sexual function. In this report, we describe management of this combination of problems to minimize postoperative morbidity and preserve a woman’s ability to have vaginal intercourse.…”

Corrosive-induced vesicovaginal fistula with procidentia: a rare occurrence

“…There have Fig. 1 Photograph showing urethral catheter coming out through VVF and accompanying prolapse been some reported cases of uterovaginal prolapse with genito-urinary fistulas, mostly resulting from poor obstetric care in women of reproductive age group or associated with long-term use of pessaries [8] in women with prolapse. However, the combination of chemical-induced fistula in longstanding procidentia is extremely rare and a Medline review of all available literature shows that this is only the second case [9] till date.…”