Article

Bilateral ureteral obstruction caused by vaginal foreign body: a case report.

Division of Urology, Department of Surgery, The University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
The Canadian Journal of Urology (Impact Factor: 0.91). 10/2009; 16(5):4870-2.
Source: PubMed

ABSTRACT We present a case of a large, vaginal calculus which eroded into the bladder ultimately causing bilateral ureteral obstruction and acute renal failure.
A 34-year-old female presented with dysuria and urinary hesitancy. The diagnosis, workup, and treatment are outlined.
Consistent with radiographic findings, the stone was a primary vaginal stone which eroded into the bladder, the nidus of the stone being a vaginal foreign body. This vaginal stone, by eroding into the bladder, caused bilateral ureteral obstruction and renal failure.
A vaginal foreign body can grow so large that it can erode into the bladder and obstruct both ureters. This stone can be treated purely endoscopically, but a later fistula repair was required in this case. Recognizing this entity and instituting the appropriate treatment may enable this to be promptly managed with minimal patient morbidity.

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    ABSTRACT: Foreign body is a rare cause of vesico-vaginal fistula most often reported in developed countries. In developing countries obstructed labor is the commonest cause of fistula. A nulliparous 19-year-old female presented with a 3-week history of a foreign body in the vagina causing urinary incontinence and offensive vaginal discharge. Her guardian allegedly inserted the foreign body after she refused a pre-arranged marriage. A plastic container was removed from the vagina under general anesthesia. A large vesico-vaginal fistula was discovered, which was successfully surgically repaired. We recommend urgent removal of the foreign body, preferably under general anesthesia. However, if the history or physical examination reveals prolonged exposure, repair of the fistula should be delayed to allow for adequate debridement in order to prevent any life-threatening complications.
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    ABSTRACT: Abstract INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae. AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature. METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013). RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal. CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation