Congenital vesicovaginal fistula

Congenital vesicovaginal fistula: spontaneous or forced? Two cases and literature review

INTRODUCTION AND HYPOTHESIS

Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously reported cases in the English literature. Theories behind the genesis of this anomaly will be briefly presented.

METHODS

We describe the presentation, diagnostic workup, and management of two patients with congenital vesicovaginal fistula. Previously reported cases were retrieved through an extensive English literature review using Medline and PubMed. Cases are tabulated based on the presence or absence of vaginal menstrual outflow obstruction.

RESULTS

Two women, aged 23 and 17, had had cyclic hematuria since puberty that was perceived as normal menstruation. One woman presented with an inability to have sexual intercourse, and the other with severe cyclic pelvic pain. Diagnostic workup unveiled congenital vesicovaginal fistula and distal vaginal agenesis in both. One had abnormal ureteric insertion, while the other had a history of anomalies unrelated to the urogenital system. Successful surgical correction of fistula was undertaken in both. An English literature review revealed 23 reported cases of congenital vesicovaginal fistula. While 74 % had concomitant menstrual outflow obstruction, the remaining had normal menstruation per vagina.

CONCLUSION

Congenital vesicovaginal fistula can present as an isolated anomaly, or associated with complex malformations of a wide spectrum. The presenting symptoms as well as the age at diagnosis vary widely. While the term "congenital" implies its genesis before birth, a congenital vesicovaginal fistula can be a manifestation of faulty embryological development, but also the result of outflow obstruction.

Congenital vesicovaginal fistula with transverse vaginal septum and ectopic ureter opening in proximal vagina: case report and brief review

Congenital vesicovaginal fistula is an extreme rarity. We report on a case of a 22-year-old lady who presented with menouria and infertility. On evaluation, she was found to have congenital vesicovaginal fistula, a nonfunctioning right kidney with ectopic ureter and transverse vaginal septum. Abdominal repair of the fistula, right nephroureterectomy, and excision of the vaginal septum was performed.

Congenital urogenital anomalies that are associated with the persistence of Gartner's duct: a review

The embryogenesis and management of congenital urogenital anomalies that are associated with ureteric ectopia and the persistence of Gartner's duct are discussed. Ureteric ectopia with Gartner's duct cyst is caused by the failure of separation of the ureteric bud from the mesonephric duct, which leads to persistence of Gartner's duct, frequently with cystic dilation. Abnormal development of the ureter subsequently causes maldevelopment or absence of the ipsilateral kidney. The diagnosis and treatment of 2 adult women with congenital urethrovaginal fistula that was associated with unilateral single ectopic ureter, renal agenesis, and Gartner's duct anomaly are presented. Surgical repair of the urethrovaginal fistulae and removal of the Gartner's duct and cyst was performed transvaginally.

Congenital vesicovaginal fistula in association with hypoplastic kidney and uterus didelphys

Abnormalities of the lower urinary and genital tracts commonly coexist, although congenital vesicovaginal fistula is extremely rare. We report the first case of congenital vesicovaginal fistula and hypoplastic kidney in association with uterine didelphys. Despite extensive investigation throughout childhood, a definitive diagnosis was not made until 16 years of age. We discuss some of the difficulties that might arise in diagnosing a small vesicovaginal fistula in the presence of a fusion abnormality of the genital tract and suggest how such cases might be investigated and managed surgically.

[Treatment approach for vesicogenital fistula. Retrospective analysis of our data]

The vesicogenital fistula are abnormal communications between female genitalia and urinary bladder. We recorded all the vesicogenital fistula diagnosed since 1986, analyzing aetiology, treatment applied, complications and results. Total number of fistula have been 20 (18 vesicovaginal and 2 vesicouterine). The distribution in vesicovaginal fistula was iatrogenic in 15 cases (83%) and tumoral in 3 cases (17%). Vesicouterine fistula were due to cesarean. The initial treatment of the iatrogenic fistula was conservative using foley catheter. Twenty percent of the patients were cured with this treatment (3 cases). Surgical repair was necessary for the other patients, using different surgical approach according to the type of the fistula, intensity and patient age. It was successful in 91% of the patients. The results shows that simple surgical approach generate less morbidity and the early intervention is not less efficient.

Surgical repair of vesicovaginal fistulas

Despite the many controversies surrounding the proper surgical repair of vesicovaginal fistulas, the current methods available allow surgeons to select the procedure best suited for each specific problem. Because each fistula is unique, surgeons will often be required to individually vary their approach and technique. Regardless of whether a transabdominal or transvaginal approach is selected, the concepts of using healthy tissue in tension-free closures and reinforcing the closures in high-risk situations will ensure success nearly all of the time. A urinary diversion should be considered in the rare situation where the fistula has failed even the most technically sound repair.

Vesico-vaginal fistula: new perspectives

The present review is based essentially on the literature relating to vesico-vaginal fistulae (VVF) published during the past 2 years. It highlights the major publications regarding aetiology, epidemiology, assessment and management, and indicates my opinions as to the significance of the various contributions. In particular, the route of repair, the value of interposition grafting and the place of diversionary procedures remain topical. Medico-legal aspects of the condition as it arises in the developed world and their impact on management strategies are also covered.