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A CASE REPORT OF URETEROVAGINAL FISTULA IN PELVIC FUSED KIDNEYS

BACKGROUND AND OBJECTIVE: The most common cause of ureterovaginal fistula is pelvic surgery. Approximately 10% of urinary fistulas may involve ureters. It was not found ureterovaginal fistula associated with pelvic fused kidneys in English literature. Fistula repair technique is significant in this case because of kidney position. CASE: An 18-year-old female with continuous urinary incontinence five days following cesarean section referred after one month. IVU showed fused pelvic kidney with left hydroureteronephrosis. Cystoscopy and dye test, under anesthesia did not show vesicovaginal fistula. Double-J catheter did not pass into the left ureter. With regard to these findings, ureterovaginal fistula was diagnosed. For repair, mid line lower abdominal incision was made. Repair procedures such as direct ureteroneocystostomy and psoas hitch was difficult because the ureteral length was short and psosas muscle was behind the pelvic fused kidneys but bladder flap was the convenient procedure that we could do in this patient. The patient was dry and IVU became normal fallowing repair. CONCLUSION: Repair techniques for ureterovaginal fistulas depend on the ureteral length proximal to the fistula such as direct ureteronecystostomy, psoas muscle hitch and bladder flap. Bladder flap is the convenient procedure in pelvic fused kidneys because of short ureter and kidneys position.