Urethrovaginal Fistula Repair with Vaginal Reconstruction: A Complex Post-Traumatic Case.

INTRODUCTION AND HYPOTHESIS: Complex urethrovaginal fistula after childhood pelvic trauma is rare and may be compounded by severe vaginal stenosis, scarring, and difficult fistula localization. This video demonstrates a multimodal strategy for restoring vaginal access, identifying a urethral fistula near the bladder neck, and performing layered repair with vaginal reconstruction.

METHODS: A 27-year-old woman presented with a 10-year history of cyclic hematuria after a childhood pelvic crush injury and previous urethral and vaginal repair. Examination revealed a blind-ending, stenotic vagina, and magnetic resonance imaging suggested a fistulous tract from the bladder neck to the scarred upper vagina. The operation combined laparoscopic exploration, ultrasound-guided vaginal puncture, cystoscopy with methylene blue localization, Foley balloon-assisted creation of vaginal access, urethrovaginal space dissection, three-layer fistula repair, and vaginal reconstruction.

RESULTS: The repair was completed with restoration of vaginal continuity. A transurethral Foley catheter was maintained for 2 weeks, and vaginal dilation was initiated on postoperative day 5. At 1-month follow-up, cyclic hematuria had resolved. Repeat cystoscopy showed complete closure of the urethral fistula without residual leakage, and vaginoscopy demonstrated circumferential healing of the reconstructed vaginal canal without stenosis.

CONCLUSIONS: Image-guided access, dye-assisted cystoscopic localization, careful urethrovaginal dissection, and layered closure can facilitate repair of selected complex post-traumatic urethrovaginal fistulas with concurrent vaginal reconstruction.