Spontenous Urethrovaginal Fistula after Advanced Pelvic Organ Prolapse

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.