Endoscopic Conservative Treatment for an Ureterovaginal Fistula Caused by Foreign Body

Foreign body placement in the vagina is a rare cause of ureterovaginal fistula. A fistula is often due to an unrecognized injury to the ureter, most commonly after gynecologic pelvic surgery, such as during hysterectomy for benign indications. This manuscript will discuss a case of a 34-year-old African American female who presents with a history of sexual assault and a one month history of urinary incontinence. Physical examination revealed clear liquid in the vaginal vault and a malodorous foreign body embedded in the vaginal mucosa. Cystoscopy ultimately confirmed a left ureterovaginal fistula. A CT cystogram was performed after removal of the foreign body, which demonstrated the size and location of the fistula. A cystoscopy, retrograde pyelography and fistulography were all performed. The patient’s kidney function was determined to be adequate with estimated creatinine clearance and the appearance of symmetric uptake of contrast on CT scan. The patient’s symptoms resolved after conservative treatment with JJ catheter stent placement for six weeks. Therefore, conservative endoscopy treatment should be considered for small fistulae. Trauma from sexual assault may be physical and emotional, and therefore, a multidisciplinary approach to treatment is paramount.