PMC9723518_01
X-ray cystogram (A) and CT cystogram (B) demonstrating vesicovaginal and vesicouterine fistulae. The urethral catheter is seen with the tip traversing the vesicouterine fistula.
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CT cystogram confirmed presence of both a vesicovaginal fistula and a vesicouterine fistula at the dome of the bladder (Fig. 1).
Cystoscopic evaluation of vesicouterine fistula at the dome of the bladder (A), large vesicovaginal fistula at the base of the bladder (B), and close proximity of left ureteral orifice to the vesicovaginal fistula (C).
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Cystoscopy demonstrated a large VVF with an associated mucosal bridge and erythematous changes at the bladder dome consistent with known VUF (Fig. 2).
Dissection of vesicouterine fistula with entrance into bladder (A). Spongestick in the vagina seen through large vesicovaginal fistula (B). Complete removal of vesicouterine and vesicovaginal fistula with left ureter dissected (C). Omental interposition flap (D).
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Approximately 5 months after injury, she underwent a robotic-assisted laparoscopic total hysterectomy with repair of both her vesicovaginal and vesicouterine fistula with omental interposition flap (Fig. 3).