Traumatic Urethrovaginal Fistula from Female Genital Mutilation Presenting as Bladder Outlet Obstruction: A Rare Case Report

Background

Urethrovaginal fistula is an abnormal communication between urethra and vagina by an epithelialized tract. In girls the cause can be congenital or post traumatic. Female genital mutilation may be associated with urethrovaginal fistula and the predominant presentation is that of continuous urinary incontinence. Presentation with bladder outlet obstruction and inability to pass urine is rare. We report a 12-year old girl with traumatic urethro-vaginal fistula post female genital mutilation who presented with inability to pass urine and bladder outlet obstruction.

Case report

This is a 12-year old girl who presented with urethral bleeding and inability to pass urine following female genital mutilation. She had suprapubic cystostomy due to failed urethral catheterization. Micturating cystourethrogram revealed huge bladder with tight bladder neck. The haemogram, urine microscopy, electrolyte urea and creatinine were within normal limits. She had examination under anaesthesia which revealed urethrovaginal fistula and obliteration of the bladder neck. She had multilayer repair of the fistula via abdominoperineal approach. Urethral catheter was removed after 6 weeks. She developed nocturnal enuresis post operatively which was managed with tolterodine.

Conclusion

Urethrovaginal fistula from female genital mutilation may present with bladder outlet obstruction. Micturating cystogram may not be diagnostic. Examination under anaesthesia may be necessary for proper diagnosis. Abdominoperineal multilayer repair is associated with good outcome.

Keywords: Urethrovaginal fistula, Female genital mutilation, Bladder outlet obstruction, Multilayer repair.

Abbreviations: FC: Female circumcision; UVF: Urethrovaginal fistula; FGM: Female Genital Mutilation; WHO: World Health Organization; NG Tube: Naso Gastric Tube; EUA: Examination under anaesthesia.