In this case, the suprapubic catheter was placed because the patient has a neurogenic bladder. However, the suprapubic catheter appears to have eroded through the posterior aspect of the urinary bladder, thus resulting in a vesicovaginal fistula. The distal tip of the catheter and the inflated balloon appear to be within the vaginal canal, just inferior to the cervix. There was no free fluid or free air in the abdomen or pelvis. Although the urinary bladder appears relatively decompressed, there is moderate bilateral hydroureteronephrosis. No obvious obstructive mass lesion or stone was seen.

Urology believed that this patient would benefit from a urinary diversion given her recurrent urinary tract infections involving a non-functional bladder, a vesicovaginal fistula, and her impaired wound healing. However, this patient has already undergone a subtotal colectomy with extended right hemicolectomy/terminal iliectomy for inflammatory bowel disease complicated by multiple enteroenteric fistulas about her ileocolic anastomosis, leading to an eventual end ileostomy. Therefore, her bowel diversion may limit her ability to have a urinary diversion.

Case courtesy of Ross Kuprien, M.D.

Additional contributor: Benjamin Jiao, D.O.