Case ReportVesicovaginal Fistula in Adolescent Girls: Incidence and Management
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
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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
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Cited by (2)
Demographics of patients with vesicovaginal fistula and its knowledge in local population
2019, Rawal Medical Journal
The authors indicate no conflicts of interest.