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Case Reports
. 2024 Feb 22:16:17562872241232581.
doi: 10.1177/17562872241232581. eCollection 2024 Jan-Dec.

Formation of vesicovaginal fistula after modified McDonald cerclage placement: a case report with literature review

Deama AlGhamdi  1 , Samera F AlBasri  2
Affiliations
Case Reports

Formation of vesicovaginal fistula after modified McDonald cerclage placement: a case report with literature review

Deama AlGhamdi et al. Ther Adv Urol. .

Abstract

Cervical cerclage is a common procedure employed to prevent preterm birth in women with cervical insufficiency. Complications such as injuries to the cervix and bladder, and premature membrane rupture are well-documented, while genitourinary fistulas are a rare occurrence. This article reports a rare case of vesicovaginal fistula (VVF) formation in a 27-year-old woman following the placement of a McDonald cervical cerclage. The patient presented with continuous watery vaginal leakage, which began during the last 2 months of her pregnancy. Clinical and cystoscopic examinations revealed the presence of a VVF, which was further confirmed through voiding cystourethrography and perineal magnetic resonance imaging. Notably, the patient had undergone the cerclage procedure 18 months prior to the onset of symptoms, making this case particularly unusual. We believe that the VVF formation was associated with the use of Mersilene tape, which may have slowly eroded through the cervix and subsequently breached the urothelium. This case underscores the importance of considering cerclage-related genitourinary fistulas as potential complications, especially when evaluating and counseling patients who have undergone cervical procedures like the McDonald technique. In conclusion, this case highlights the need for vigilant monitoring and a high index of suspicion in patients presenting with symptoms of genitourinary fistulas after such procedures. Further research and awareness in this area are warranted to better understand the risk factors and mechanisms underlying this unusual complication.

Keywords: bladder fistula; cervical cerclage; urine incontinence; urogenital fistula; vaginal fistula; vesicovaginal fistula.

Plain language summary

Our patient presented with continuous watery leakage that started during the last 2 months of her pregnancy. The patient was diagnosed with an abnormal communication between the bladder and vagina following the placement of cervical Mersilene tape. After 18 months, the opening was repaired, and the patient fully recovered 2 months after surgery. Complications associated with cerclage are rare and commonly related to injuries to the cervix or bladder, premature rupture of membranes, chorioamnionitis, and bleeding, as described in published reports. This case report described the unusual complication of vesicovaginal fistula formation after the placement of a McDonald suture. We emphasize that vesicovaginal fistula can have a serious impact on social, mental, and sexual health. Any practitioner dealing with such patients should be aware of these associated health problems during management.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Leakage of stained urine from the fistula tract.
Figure 2.
Figure 2.
Insertion of a pediatric Foley catheter (size 5 Fr) into the fistula.
Figure 3.
Figure 3.
Cystoscopic image showing the fistula opening near the ureteral orifice.
See this image and copyright information in PMC

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