Simultaneous Ureterovaginal and Rectovaginal Fistulas Caused by a Cube Pessary: A Case Report

Abstract

Introduction

We present a case of simultaneous ureterovaginal and rectovaginal fistulas caused by continuous placement of a cube pessary without daily removal, successfully managed through a multidisciplinary approach.

Case Presentation

An 84-year-old female managed with a cube pessary presented with hematochezia. Initial imaging revealed simultaneous pessary penetration into the rectum and right ureterovesical junction. A previous hospital first performed a sigmoid colostomy and an unsuccessful transvaginal rectovaginal fistula closure. Following this, a ureteral stent was placed for the ureterovaginal fistula, but it also failed to close due to extensive tissue defects. She was referred to our hospital, where a multidisciplinary surgery incorporating retroperitoneal extravesical ureteroneocystostomy, transvaginal fistula closure, and anterior colporrhaphy was performed.

Conclusion

Cube pessaries require daily self-management, and continuous placement in elderly patients can lead to severe ischemic complications. Multidisciplinary surgical reconstruction is crucial to preserve renal function and restore quality of life.