Intravesical Herniation of Tubal Fimbria Through Vesicovaginal Fistula Associated with Ureterovaginal Fistula Mimicking Bladder Mass: A Case Report of Unreported and Undescribed Hernia

Sankapal Prakash; Gite Venkat  Arjunrao; Agrawal Mayank; Maheshwari Mudit; Sharma Shashank

doi:10.18502/jri.v24i1.11911

Sankapal Prakash Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India
Gite Venkat Arjunrao Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India
Agrawal Mayank Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India
Maheshwari Mudit Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India
Sharma Shashank Department of Urology, Grant Government Medical College & Sir JJ Hospital, Mumbai, India

DOI: https://doi.org/10.18502/jri.v24i1.11911

Keywords: Bladder mass, Fimbria, Incontinence, Ovarian cyst, Ureterovaginal fistula, Vesicovaginal fis-tula.

Abstract

Background: One of the few remaining important issues in urological and gynaecological surgery relates to fistulas between the urinary tract and the vagina. Vesicovaginal fistula (VVF) and ureterovaginal fistulas (UVF) are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other.

Case Presentation: This study is about an unreported and undescribed case of 24 year old female who presented with the complaints of continuous urinary incontinence for 18 months following total abdominal hysterectomy. Preoperative cystoscopy and vaginal/speculum findings revealed a papillary frond like mass protruding intravesically from VVF site which was free from the edges of fistulous opening all around. Also, left ureteric orifice was not visualized. On exploration, there was evidence of intravesical herniation of right tubal fimbria through the common opening of VVF and left UVF near left vaginal vault apex mimicking a bladder mass presenting with continuous incontinence for 18 months. Modified O' Conners VVF repair with left ureteric reimplantation was done. The postoperative period was uneventful with patient having no incontinence.

Conclusion: It seems that surgical resection of ovarian cyst with VVF and UVF repair is the definitive treatment and histopathological examination is essential to exclude malignant transformation.