Endourologic diagnosis and treatment of ureterouterine fistula

A rare case of ureterouterine fistula following a dilatation and evacuation for elective abortion is presented. According to the literature, most cases are related to elective abortion. A 42-year-old woman, 1-0-5-1, presented with copious watery vaginal discharge from the cervical os. She had had an elective abortion followed by a laparotomy for a suspected uterine perforation with peritonitis 1 months prior to presentation. She underwent another laparotomy, which revealed only adhesion of the terminal ileum, appendix and adnexae based on the hysterogram, which suggested an enterouterine fistula. The right ureterouterine fistula was not diagnosed until an antegrade pyelogram was undertaken. She was subsequently treated with temporary percutaneous nephrostomy drainage followed by ureteroneocystostomy. It was concluded that the ureterouterine fistula was most likely caused by the lateral path of abortion instruments into the retroperitoneal space, with trauma to the right ureter.