Vesico-Vaginal Fistula (HSG)

Vesico-Vaginal Fistula – Hysterosalpingography

HSG

Vesico-vaginal fistula is an abnormal communication between the urinary bladder and the vagina. It most commonly results from obstetric trauma, pelvic surgery (especially hysterectomy), radiation therapy, or pelvic malignancy. On contrast studies and occasionally on hysterosalpingography (HSG), contrast introduced into the vagina or uterine cavity is seen directly opacifying the urinary bladder.

Fig-1

Fig. 1—Contrast study demonstrating passage of contrast from the vaginal canal into the urinary bladder (arrows), confirming vesico-vaginal fistula.

Findings: The uterine cavity may appear normal. Early opacification of the urinary bladder is seen following vaginal or uterine contrast instillation, with pooling of contrast within the bladder.

Conclusion: Imaging features are consistent with vesico-vaginal fistula.

Patient Symptoms

Patients typically present with continuous urinary leakage per vagina, recurrent urinary tract infections, foul-smelling vaginal discharge, and perineal irritation.

Procedure (Hysterosalpingography)

When evaluated during HSG, contrast is injected gently under fluoroscopic control. Low-pressure injection is essential to avoid further tissue damage.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 5–8 mL is administered slowly in the lithotomy position.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Vaginal catheter or cannula
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

Active infection is a contraindication. Excessive injection pressure should be avoided to prevent enlargement of the fistulous tract.

Related Conditions

Differential diagnoses include vesico-uterine fistula, recto-vaginal fistula, uterine fistula, post-surgical vaginal defects, and radiation-induced pelvic injury. Correlation with cystography, CT, or MRI is recommended.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.