URETEROVAGINAL FISTULA AFTER VAGINAL DELIVERY

Abstract

Ureterovaginal fistula is a serious sequela of ureteral injuries and is usually encountered after gynecological and obstetrical pelvic surgeries.' Vesicovaginal fistulas occur between the urinary tract and vagina after vaginal delivery.2 We report a case of ureterovaginal fistula after a prolonged and difficult vaginal delivery, which was treated with ureteroneocystostomy (reimplantation of the ureter into bladder). CASE REPORT A 48-year-old woman was referred to our clinic for evaluation of continuous dribbling, urinary incontinence, dysuria and frequency 7 years aRer a difficult vaginal delivery of her sixth child. Normal voiding occurred every few hours. History, including trauma to the pelvis or abdomen and abdominal or pelvic surgery, was unremarkable. Endourological manipulation had not been done and no drug was consumed regularly. The patient began menopause a year previously. A test for tuberculosis was negative. Physical examination revealed a dystrophic ulcer in the perineal and genital area. Examination with a speculum demonstrated persistent urine discharge in the vaginal area and a fistula orifice in the vaginal anterior wall. Cystoscopy showed a normal urethra and bladder with no signs of fistula. A ureteral sound was passed on the left side without difficulty but the sound could only be passed less than 1 cm. on the right side. The bladder was filled with 400 cc normal saline and methylene blue solution, and no extravasation of urine into the vaginal area was observed. Excretory urography revealed a double collecting system on the left side without dilatation and a dilated pyelocaliceal system on the right side. A cystogram and all clinical tests were normal. Diagnosis was ureterovaginal fistula, and exploration and reimplantation of the ureter were performed. After opening the abdominal wall and performing a hysterectomy, the bladder was opened, and 2 ureteral sounds were passed through