• James Fergus Donaldson, Campbell Tait, Marcel Rad, Shonagh Walker, Thomas B L Lam, Mohammed Abdel-Fattah, and Satchi Kuchibhotla Swami.
• Department of Urology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
• J Sex Med. 2014 Oct 1; 11 (10): 2595-600.

IntroductionVaginal foreign bodies (FBs) are a rare cause of vesicovaginal, rectovaginal, or urethrovaginal fistulae.AimThe aim of this study was to describe a rare case of vesicovaginal fistula (VVF) and obstructive uropathy and to review the literature.MethodsA case is presented. A comprehensive review of the literature was performed (1948-2013).ResultsA 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.ConclusionsThis 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.© 2014 International Society for Sexual Medicine.

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