Spontenous Urethrovaginal Fistula after Advanced Pelvic Organ Prolapse - Abstract
Urethrovaginal fistula is a rare occurrence with unknown prevalence, Common
causes of urethrovaginal fistulas are complicated vaginal deliveries, damage to the
urethra during vaginal surgery, (particularly excision of urethral diverticulum) and
surgery of the anterior vaginal wall including synthetic slings [1]. Rare etiologies of
urethrovaginal fistulas include vaginal hysterectomy, pressure necrosis from improperly
managed long-term indwelling catheters, pelvic fracture injury causing laceration of
the urethra, and local invasion from adjacent malignancies and radiation therapy [2].
Pelvic Organ prolapse (POP) is a common condition that accounts for about
400,000 surgeries annually in the United States [3]. The lifetime risk of having surgery
for POP or urinary incontinence at the age of 80 is about 11.1 % [4]. Additionally,
advanced POP is more likely to be symptomatic and in need for treatment. Reported
POP related complications include: Recurrent urinary tract infections, urinary
incontinence, urinary retention, hydronephrosis, and vaginal skin ulceration, this is in
addition to the reported rare complication of bladder rupture [5-8]. In this study we
present a case of spontaneous urethrovaginal fistula in an elderly lady, who didn’t
receive treatment for procidentia for at least 8 years. To our knowledge this is the
only reported case of urethrovaginal fistula in the presence of Pelvic Organ Prolapse.