@article{ref1,
title="Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina",
journal="Journal of sexual medicine",
year="2014",
author="Donaldson, James Fergus and Tait, Campbell and Rad, Marcel and Walker, Shonagh and Lam, Thomas B. L. and Abdel-Fattah, Mohammed and Swami, Satchi Kuchibhotla",
volume="11",
number="10",
pages="2595-2600",
abstract="INTRODUCTION: Vaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae. <br><br>AIM: The aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature. <br><br>METHODS: A case is presented. A comprehensive review of the literature was performed (1948-2013). <br><br>RESULTS: A 38-year-old woman presenting with sepsis, obstructive uropathy, and severe emaciation was found to have a sex toy retained in her vagina for 10 years. This had caused a VVF and bilateral hydroureteronephrosis. Bilateral nephrostomies were inserted and she underwent cystoscopy and examination under anesthesia (EUA) with retrieval of FB. A left ureteric stricture was demonstrated. Transabdominal VVF repair with omental flap and left ureteric re-implantation was performed. The VVF recurred, which was successfully re-repaired transvaginally. Seventy-six full text articles were reviewed. There were no previously published cases of VVF following vaginal sex toy insertion. There are four cases of obstructive uropathy secondary to a vaginal FB in the literature: three pessaries and one plastic cap. There are 44 cases of VVF secondary to FB: 22 plastic caps (typically from aerosol bottles, inserted for masturbation or contraception) and 5 pessaries. At least nine were in girls aged ≤18 years. Average presentation is 15 months (range 2 months to 35 years) after FB insertion. Most cases were managed with surgical repair; predominantly transvaginal. <br><br>CONCLUSIONS: This case describes an extremely rare but potentially life-threatening case of obstructive uropathy caused by a chronically retained sex toy, and adds to the list of potentially rare causes of a VVF and obstructive uropathy. We advocate urinary diversion, staged removal of FB, upper urinary tract imaging, and EUA with VVF repair and/or ureteric reimplantation if required. Transvaginal is the preferred access for FB-associated VVF repair without concomitant ureteric reimplantation. Donaldson JF, Tait C, Rad M, Walker S, Lam TBL, Abdel-Fattah M, and Swami SK. Obstructive uropathy and vesicovaginal fistula secondary to a retained sex toy in the vagina. J Sex Med **;**:**-**.<p /> <p>Language: en</p>",
language="en",
issn="1743-6095",
doi="10.1111/jsm.12575",
url="http://dx.doi.org/10.1111/jsm.12575"
}