Julia R. Fielding, M.D. Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts

41 Year-old female with Persistent Perineal Wetness

This 41 year-old female with a history of surgical resection of cervical carcinoma presented with persistent perineal wetness. Voiding cystourethrogram demonstrated no abnormalities, thereby excluding a vesicovaginal fistula. An intravenous pyelogram was performed to assess the upper tracts (Figures 1 and 2). A left posterior oblique projection performed 15 minutes following injection of intravenous contrast (Figure 1) shows an abnormal contour of the bladder dome; a lateral view was then performed (Figure 2) showing contrast within the vagina and bladder diagnostic of a ureterovaginal fistula. This was confirmed at operative exploration and repaired using a psoas hitch.