Author(s): Methfessel HD
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Abstract Fistulae between kidney and vagina caused by foreign bodies are very rare nowadays. Two casuistics illustrate the curious anamnesis of such patients: in an 18-year-old girl a foreign body inserted during masturbation led to a perforation, in the case of a 66-year-old woman a pessary which had been forgotten since 35 years penetrated into the urinary bladder. PIP: 2 cases of penetration of foreign bodies into the bladder via the vagina with resulting fistula formation are discussed. Routine gynecological examination of the 1st patient, an 18 year old girl, revealed copious, thin discharge in the vagina and a pointed foreign body sticking in the vaginal vault. The foreign body, a plastic splinter, was removed, leading to drainage of urine from the wound. Upon questioning, the patient admitting masturbation with a plastic spray bottle some months before. In attempting to remove the cap from the vagina, it had splintered. A plastic shard had remained in the base of the bladder, above the trigonum. After local treatment of vulva and vagina, the fistula in the bladder was repaired by the Fueth method. Only after peritomization was the introverted fistula fully fixated by a balloon catheter. The 2nd patient, a 66 year old woman, had expelled a 35 year old Keradenta occlusive pessary one morning, followed by involuntary loss of urine. Examination revealed perforation of the bladder, directly behind the internal urethral orifice. The fistula was trimmed and sutured through the vagina. The unusual feature of the latter case was the absence of any complaints for 35 years. The standard principles of fistula surgery apply to treatment of foreign body fistulas. However, enough time for local pretreatment should be taken in order that concomitant inflammatory reactions in the hollow organs can diminish.
This article was published in Z Urol Nephrol
and referenced in Journal of Pain & Relief