An Outside-the-Box Approach for Treating a Rare Case of Urethrovaginal Fistula

Urethrovaginal fistulas are rare complications often arising from urethrovaginal injuries commonly due to obstetrical trauma, urethral surgeries, pelvic fractures, or neoplastic treatments. Here, we present a unique case involving a 23-year-old female patient with a large urethrovaginal fistula and complete anterior vaginal wall sloughing following prolonged obstructed labor. Nine months post-cesarean, she reported urine leakage via the vagina upon catheter removal, which intensified in an erect posture. Clinical examination revealed an absent urethra and a wide bladder neck with the posterior bladder wall visible through the vaginal introitus, indicating severe tissue loss. Following interdisciplinary consultations, a novel reconstructive surgery was planned under urology. During surgery, the bladder and ureters were safeguarded using double J (DJ) stents, and a neo-urethral tube was fashioned from a strip of the anterior vaginal wall. The bladder neck was narrowed, and artificial dermal collagen (Matriderm®) was applied as an interpositional waterproof layer, representing an innovation previously undocumented in similar cases. Postoperative recovery was uneventful, and after catheter removal, the patient regained continence and normal urinary function. This case suggests a potential role for dermal substitutes in urological reconstructions, particularly in cases requiring waterproof tissue closures, which warrants further investigation.