Removal of an Intravesical Gellhorn Pessary and Staged Repair of a Residual Large Vesico-Vaginal Fistula.

This case report demonstrates the removal of an intravesical Gellhorn pessary and management of a large vesicovaginal fistula. A 79-year-old woman with a history of pelvic organ prolapse treated with a Gellhorn pessary three years prior presented with recurrent urinary tract infections and continuous urinary leakage. CT imaging showed the pessary to be intravesical. After surgical clearance, she underwent cystoscopy and vaginoscopy under anesthesia with the goal of transvaginal removal. The pessary was fully embedded in the bladder lumen and could not be mobilized using laser transection, cutting, or grasping techniques. A guidewire was passed through a pessary drainage port and retrieved endoscopically, allowing counter-traction to gradually mobilize the pessary sideways. It was grasped with clamps and removed transvaginally through the large fistula site. Two-month follow-up cystoscopy showed resolution of bladder inflammation. MRI with vaginal contrast demonstrated a persistent large vesicovaginal fistula. Due to age and medical frailty, she underwent Latzko colpocleisis with suprapubic catheter placement for bladder drainage. At four weeks, cystography confirmed fistula closure. At the last follow-up, the patient reported no leakage, normal voiding, and resolution of infections.