Case Report
Vesicovaginal Fistula in Adolescent Girls: Incidence and Management

https://doi.org/10.1016/j.jpag.2015.04.009Get rights and content

Abstract

Background

The purpose of the study was to analyze the incidence, causes, and management of vesicovaginal fistula (VVF) in adolescent girls.

Cases

Three girls of adolescent age were diagnosed with VVF, caused by a vaginal foreign body (ie, an aerosol spray cap). Transvesical reconstruction was performed in 2 cases. After the diagnosis of VVF, the third girl was discharged home with Foley catheter drainage. Three months later, she presented with pregnancy and was lost to follow-up.

Summary and Conclusion

Evaluation of unusual urinary symptoms in an adolescent should include vaginal examination and/or imaging. Aerosol spray caps remain the most common vaginal foreign body resulting in VVFs in adolescent girls in Lithuania. Transvesical reconstruction is safe and efficient.

Introduction

Vesicovaginal fistula (VVF) is an abnormal fistulous tract between the vagina and the urinary bladder, subsequently resulting in involuntary urine discharge into the vaginal vault. It is the most common type of urinary tract fistula in adults, comprising 64% according to some reports.1 VVF is a rare condition in adolescent age in developed countries and only sporadic cases are described in the literature.2 In developing countries, VVF is often associated with pregnancy at a young age, because more than 50% of patients were pregnant before the age of 18 according to the World Health Organization. In contrast, 4% of genital complaints, 18% of vaginal discharge cases, and 50% of vaginal bleeding cases have been reported to be caused by vaginal foreign bodies in prepubertal girls.3 The most common age at which foreign bodies are found in the vagina is between 3 and 9 years of age.3 Children usually insert foreign bodies because the genital area might be itchy, as a result of body exploration, due to behavior related to sexual abuse, or on purpose for sexual gratification.3

Section snippets

Cases

Medical registries were reviewed for all patients who received surgery for VVF at both of the principal pediatric surgical centers in Lithuania from 2001 to 2013. We found 3 cases of VVF in adolescent girls during that time. All girls were admitted to the hospital because of a VVF caused by a vaginal foreign body, which was later found to be an aerosol spray cap in all cases (Fig. 1). One girl introduced the foreign body herself with the intent of masturbation. The true reason in the other 2

Summary and Conclusion

All 3 recorded cases in Lithuania in this 13-year period occurred because of the same reason, which might reflect the preferences and lack of sexual education in this age group. The incidence rate based on data from the Lithuanian Department of Statistics on the number of adolescent girls in 2001-2013 was 1 in 500,000 person-years. Symptoms caused by a vaginal foreign body include vaginal bleeding, a blood-stained, malodorous vaginal discharge, suprapubic pain, defecatory obstruction, and

References (8)

  • W.S. Reynolds et al.

    Vesicovaginal fistula repair with rectus abdominus myofascial interposition flap

    Urology

    (2008)
  • R. Mathur et al.

    Urogenital fistulae: a prospective study of 50 cases at a tertiary care hospital

    Urol Ann

    (2010)
  • A. Puppo et al.

    Vesicovaginal fistula caused by a vaginal foreign body in a 72-year-old woman: case report and literature review

    Int Urogynecol J Pelvic Floor Dysfunct

    (2009)
  • F.T. Closson et al.

    Vaginal foreign bodies and child sexual abuse: an important consideration

    West J Emerg Med

    (2013)
There are more references available in the full text version of this article.

The authors indicate no conflicts of interest.

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