Vesicovaginal fistula formation after oocyte retrieval

Abstract

Development of a vesicovaginal fistula (VVF) is a devastating condition that has profound effects on both the physical and psychological health of a patient [1]. VVF is uncommon in the developed world. In modern urological practice, around 90% of cases are caused by inadvertent injury to the bladder during surgery [2]. The reported incidence after pelvic surgery is 0e52% [3]. Other less common causes include pelvic malignancy, pelvic irradiation, obstetric trauma, and infection including tuberculosis [4]. Transvaginal ultrasound-guided oocyte retrieval has been performed since 1985 [5]. It is a safe and well-tolerated procedure. In this technique, oocytes are collected by passing a 16e18 gauge needle attached to a transducer through the vaginal wall in the lateral superior fornices under ultrasound (US) guidance into the stimulated ovarian follicles. The main reported complications are minor vaginal bleeding and pelvic infection. Injuries to the surrounding organs, such as the bowel and bladder or large vessels, are rare. In the literature, a few case reports of ureterovaginal fistula have been found, but to our knowledge, VVF formation after oocyte pickup has not been reported [6]. Recent advances have improved the success ofVVF repairda challenge that can test even the most experienced gynecologic surgeon. For example, it is now apparent that small, uncomplicated fistulae respond well to conservative treatment [7]. Here, we present a rare case of VVF after US-guided oocyte retrieval and its conservative management in the form of continuous urinary catheter drainage for 3 weeks’ duration. The patient was a 28-year-old woman P0 þ 1 referred from the Assisted Conception Unit to the urogynecology clinic at a university hospital after embryo transfer with a history of passing watery vaginal discharge requiring a pad. The couple had infertility due to a male factor and was on the second cycle of in vitro fertilization (IVF). Oocyte retrieval was performed by a junior consultant at a private center using a single-lumen 16gauge needle. Day 3 after oocyte retrieval, three embryos