Spontaneous closure of urethrovaginal fistula associated with pelvic fracture
A 45-year-old female sustained pelvic fracture with urethral injury due to a road traffic accident. Initial resuscitation, orthopedic management with internal fixation of the pubic bone, and suprapubic urinary diversion were done elsewhere. Suprapubic catheter was removed after 3 weeks. She was leaking urine from the vagina after the removal of the suprapubic catheter. She consulted us after 3 months of the initial injury with history of continuous leakage of the urine per vaginum. On pelvic examination, urine was seen emanating from the vagina and a scar was felt in the proximal vagina. Cystogram demonstrated the urethrovaginal fistula []. She was advised to get admitted for further management but she refused. She came after 15 days with acute urinary retention and cessation of the urinary leak per vaginum. Initial suprapubic urinary diversion was done followed by examination under anesthesia. Dense fibrosis with scarring was felt in the proximal vagina. On filling the bladder with methylene blue through the suprapubic catheter, no leak was demonstrable through the vagina. Retrograde urethrocystoscopy was not possible due to complete urethral obliteration. Antegrade cystoscopy revealed normal bladder wall along with complete obstruction and scarring at the level of bladder neck. A Mitrofanoff procedure was performed using the tapered ileal segment as intraoperatively, the appendix was found to be very short. She was discharged in satisfactory condition and is doing well till the last follow-up.