Vesicovaginal fistula formation after cervical cerclage.

Abstract

Although a vesicovaginal fistula is a rare complication of cervical cerclage, there have been multiple case reports that demonstrated this complication, and it is important for providers to consider the possibility of a fistula so that there is early identification and management. It is important to keep in mind the risk factors, such as a previous cerclage and multiparity. In addition, patients should undergo prompt assessment for a fistula using cystoscopy when patients report alarming symptoms, such as dysuria and urinary incontinence. We present a patient who was found to have a vesicovaginal fistula following placement of a cerclage for a history of cervical insufficiency and describe our approach to the diagnosis and a transvaginal surgical repair in the intrapartum period. We first used cystoscopy to identify the fistula. Next, using a transvaginal approach, we removed the cerclage and then entered the vesicovaginal space. After identifying the fistulous tract, we introduced a grasper through the operative channel of the cystoscope and abraded the edges of the bladder mucosal defect. Subsequently, using a transvaginal approach, the fibromuscularis layer was reinforced to ensure apposition of the bladder mucosa, followed by re-approximation of the vaginal epithelium to encourage secondary healing. The patient was maintained on bladder rest with a catheter and had symptom resolution within a week, followed by an uncomplicated term delivery.