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Urinary Incontinence After Ovarian Cancer, TAH/BSO

Urinary Incontinence After Ovarian Cancer, TAH/BSO

  • 50-year-old patient with ovarian cancer and total abdominal hysterectomy presented with urinary incontinence.
  • Figure 1. Contrast in rectum enters UB.
  • Figure 2. Pevic mass seen with contrast entering necrotic area.
  • Figure 3. Contrast seen entering vagina.
  • Figure 4. Contrast seen entering vagina.
  • Figure 5. Fecal matter in urinary bladder.
  • Figure 6. Fecal matter in urinary bladder.
  • In most instances, the diagnosis is suspected clinically due to pneumaturia, fecaluria, recurrent urinary tract infections, or passage of urine rectally.
  • In most cases, the fistula occurs through the dome of the bladder (~60%).
  • On CT, the fistula will be heralded by the presence of gas within the lumen of the bladder or, less frequently, direct demonstration of the tract itself.
  • When the communication is between the rectum and urinary bladder, the term rectovesical fistula is used.
  • Diverticulitis is the most common cause.
  • Surgical resection of the fistula and abnormal segment of bowel is usually required for cure, although in the setting of malignancy, this suggests advanced disease (T4) making surgery complex.
  • A fluoroscopic cystogram is a commonly-used method for evaluating vesicovaginal fistulas.
  • The fistula may be seen as a hypodense area with excretion of contrast into the vagina on a delayed CECT film.
  • Vesicovaginal fistulas are abnormal fistulous connections between the urinary bladder and vagina, resulting in involuntary discharge of urine through the vagina.
  • Causes include prolonged obstructed labor (most common in developing countries).

Case History: 50-year-old patient with ovarian cancer and total abdominal hysterectomy presented with urinary incontinence.

Comments

colovesical and colovaginal fistula

mondher @

colovesical and colovaginal fistula

mondher @

Recurrent mass and vesicovaginal fistula

masoud @

Colo-vesical fistula, markedly thicked bladder wall.

herbert @

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