Vesico-vaginal fistula post cold cup bladder biopsy: mini review

Abigail Mawhinney^1,*, Ammar Hameed^2,*, Ali Thwaini¹, Colin Mulholland^1
1Belfast City Hospital, Urology Department, Belfast, Northern Ireland, UK; ²Addenbrookes University Hospital, Urology Department, Cambridge, UK
*These authors contributed equally to this paper

Introduction: We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.
Methods and results: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.
Conclusion: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

Keywords: vesico-vaginal fistula, vaginal fistula, surgical repair of vaginal fistula, management of vaginal fistula