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Ureterovaginal Fistula Detected by Vaginogram

J. N. Macaluso Jr, MD; R. A. Appell, MD; J. W. Sullivan, MD
JAMA. 1981;246(12):1339-1340. doi:10.1001/jama.1981.03320120043027.
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URINARY tract fistula as a complication of various surgical procedures is a well-known entity.1-3 The detection of a ureterovaginal fistula after radical Wertheim hysterectomy demonstrates the vaginogram as an aid in radiological evaluation and diagnosis.

Report of a Case  A 39-year-old woman underwent a radical Wertheim hysterectomy for carcinoma of the cervix without apparent complication. The patient received 4,500 rad of pelvic irradiation postoperatively owing to lymphatic spread of the carcinoma. Shortly thereafter the patient began to experience a watery vaginal discharge. Initial evaluation by intravenous (IV) pyelogram was nondiagnostic (Fig 1). Both ureters were visualized to the ureterovesical junction without demonstration of any definite fistula. Cystourethroscopy did not disclose evidence of a fistula or other vesical abnormalities. Both ureteral orifices were easily identified, and clear efflux from the right one was demonstrated. However, efflux of urine from the left ureter could not be visualized, and attempts at left ureteral

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