Vesicovaginal fistula, bladder calculus, retained foreign body or all of the above? The unusual presentation of a female with total urinary incontinence

A 78-year-old female with total urinary incontinence was referred to Tygerberg Hospital. On physical exam a firm mass consistent with a stone was palpated along the anterior vagina and confirmed with KUB X-ray and ultrasonography. Under general anesthesia cystolithalopaxy was performed and the vaginal component was removed manually. A foreign body (aerosol cap) was identified in the vagina as the underlying cause. The aerosol cap had eroded through the anterior vaginal wall resulting in a vesicovaginal fistula. A biopsy of the fistulous tract demonstrated granulation tissue with no evidence of malignancy. A discussion of retained foreign bodies causing vesicovaginal fistula, specifically aerosol bottle caps, follows. (C) 2014 Pan African Urological Surgeons' Association. Production and hosting by Elsevier B.V.