A Hidden Surgical Challenge: Ureterovaginal Fistula Encountered During Vesicovaginal Fistula Repair

The concurrent occurrence of vesicovaginal and ureterovaginal fistulas following hysterectomy is rare, accounting for less than 1% of post-hysterectomy urinary fistulas, leading to significant physical and psychological distress. We present the case of a 36-year-old woman referred for evaluation of continuous urinary leakage following laparoscopic hysterectomy for fibroid uterus, with an initial clinical suspicion of vesicovaginal fistula (VVF). However, a comprehensive diagnostic assessment using multiple imaging and endoscopic modalities revealed an occult right ureterovaginal fistula (UVF). This finding highlights the growing need for a thorough preoperative evaluation to avoid missed diagnoses and ensure appropriate surgical planning. She underwent simultaneous right ureteric reimplantation and vesicovaginal fistula repair, resulting in complete resolution of urinary leakage. Her postoperative course was uneventful, with satisfactory recovery and no recurrence of symptoms during follow-up. This case underscores the critical importance of meticulous preoperative evaluation in patients presenting with VVF. A high index of clinical suspicion, combined with appropriate imaging modalities, is essential to identify any coexisting UVF and ensure accurate, comprehensive surgical planning. Failure to detect and address a concomitant UVF during the initial VVF repair may result in persistent urinary leakage, despite an otherwise successful procedure. Long-term postoperative follow-up is crucial to monitor for delayed complications and ensure sustained clinical resolution.