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).