Abstract
ABSTRACT
Urinary incontinence often goes undiagnosed because of a patient's reluctance to mention incontinence-related symptoms. We report a case of a symptomatic vesicovaginal fistula that went undiagnosed for 47 years. A 74-year-old, gravida 4, para 4, white woman complained to her gynecologist of vaginal bleeding of 3 months duration and pelvic pressure that had progressively worsened over the last 6 years. Further questioning revealed an astonishing 47-year history of urinary incontinence. She was diagnosed with uterine prolapse, endometrial cystic hyperplasia, and urinary incontinence and was referred for a presurgical urogynecologic evaluation. Inspection revealed a cystocele to the introitus. Speculum examination revealed obvious leakage during filling of the bladder from a defect in the anterior vaginal wall. Cystourethroscopy confirmed a vesicovaginal fistula, which was surgically repaired using a multiple-layer closure technique, resulting in postoperative continence. Fistula formation, regardless of etiology, should be an important consideration in the differential diagnosis of urinary incontinence. (J GYNECOL SURG 12:205, 1996)
Get full access to this article
View all access options for this article.