Unrecognized small vesicovaginal fistula as a cause of persistent urinary incontinence.

Three cases of persistent urinary incontinence from unrecognized small vesicovaginal fistula after abdominal hysterectomy for benign gynecologic disease are presented. Visualization of urine in the posterior fornix was suggestive; diagnosis was confirmed by methylene blue test and cystoscopy. Two patients had undergone interval Marshall-Marchetti-Krantz operations for suspected stress-related urinary incontinence. An extensive literature survey confirms that the vesicovaginal fistula were an unlikely complication of the Marshall-Marchetti-Krantz procedure.