Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina

James Fergus Donaldson, Campbell Tait, Marcel Rad, Shonagh Walker, Thomas B L Lam, Mohammed Abdel-Fattah, Satchi Kuchibhotla Swami

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.

AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.

METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013).

RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal.

CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.

Original languageEnglish
Pages (from-to)2595-2600
Number of pages6
JournalThe Journal of Sexual Medicine
Volume11
Issue number10
Early online date12 Jun 2014
DOIs
Publication statusPublished - Oct 2014

Fingerprint

Vesicovaginal Fistula
Play and Playthings
Vagina
Foreign Bodies
Pessaries
Replantation
Plastics
Anesthesia
Emaciation
Masturbation
Urinary Diversion
Cystoscopy
Aerosols
Urinary Tract
Contraception
Fistula
Sepsis
Pathologic Constriction

Keywords

  • vesicovaginal fistula
  • urinary fistula
  • vaginal fistula
  • foreign bodies
  • renal insufficiency
  • acute kidney injury
  • sex toy

Cite this

Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina. / Donaldson, James Fergus; Tait, Campbell; Rad, Marcel; Walker, Shonagh; Lam, Thomas B L; Abdel-Fattah, Mohammed; Swami, Satchi Kuchibhotla.

In: The Journal of Sexual Medicine, Vol. 11, No. 10, 10.2014, p. 2595-2600.

Research output: Contribution to journalArticle

Donaldson, JF, Tait, C, Rad, M, Walker, S, Lam, TBL, Abdel-Fattah, M & Swami, SK 2014, 'Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina' The Journal of Sexual Medicine, vol. 11, no. 10, pp. 2595-2600. https://doi.org/10.1111/jsm.12575
Donaldson, James Fergus ; Tait, Campbell ; Rad, Marcel ; Walker, Shonagh ; Lam, Thomas B L ; Abdel-Fattah, Mohammed ; Swami, Satchi Kuchibhotla. / Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina. In: The Journal of Sexual Medicine. 2014 ; Vol. 11, No. 10. pp. 2595-2600.
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abstract = "INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013).RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal.CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.",
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T1 - Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina

AU - Donaldson, James Fergus

AU - Tait, Campbell

AU - Rad, Marcel

AU - Walker, Shonagh

AU - Lam, Thomas B L

AU - Abdel-Fattah, Mohammed

AU - Swami, Satchi Kuchibhotla

N1 - © 2014 International Society for Sexual Medicine. Acknowledgment Thanks to Paul Manson for his assistance with the literature search. The authors have no funding to declare.

PY - 2014/10

Y1 - 2014/10

N2 - INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013).RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal.CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.

AB - INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013).RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal.CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation.

KW - vesicovaginal fistula

KW - urinary fistula

KW - vaginal fistula

KW - foreign bodies

KW - renal insufficiency

KW - acute kidney injury

KW - sex toy

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