Large cystocele with spontaneous vesicovaginal fistula.

Vesicovaginal fistulae (VVF) caused by cystoceles are very rare. To date, there are no documented cases in English literature. A 77-year-old woman presented with near total incontinence. On physical examination, she was found to have severe vaginal atrophy and pressure necrosis of the anterior vaginal wall, which caused partial thickness erosion and breakdown of the mucosa. A fistula had formed but there was no obvious full thickness necrosis. She underwent a combined vesicovaginal fistula repair with pubovaginal sling.