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Removal of an Intravesical Gellhorn Pessary and Staged Repair of a Residual Large Vesico-Vaginal Fistula
Published on: April 14, 2026
Simultaneous Ureterovaginal and Rectovaginal Fistulas Caused by a Cube Pessary: A Case Report
Tetsuhiro Yano1, Yutaro Sasaki1, Riyo Kinouchi2
1Department of Urology Tokushima University Graduate School of Biomedical Sciences Tokushima Japan.
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.
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