A Case of Vesicovaginal Fistula and Obstructive Uropathy Caused by a Long-Forgotten Incarcerated Vaginal Pessary

Aim & Background: Vaginal ring pessaries are a common and effective non-surgical treatment for pelvic organ prolapse, but their long-term use requires regular monitoring. A forgotten or neglected pessary can lead to serious complications, including vaginal erosion, infection, and fistula formation. This report describes a severe case of vesicovaginal fistula resulting from an incarcerated pessary. Case Description: A 74-year-old woman presented with a one-month history of continuous urine dribbling. She had a ring pessary inserted for uterine prolapse five years prior but had been lost to follow-up for the last four years. On examination, the pessary was found deeply embedded within the vaginal mucosa, creating a dense, solid mold. A CECT urogram revealed the pessary was impacted along the posterolateral wall of the bladder, causing a vesicovaginal fistula and secondary left-sided hydroureteronephrosis. The pessary was successfully removed under anesthesia via railroading technique. Conclusion: Long-forgotten pessaries can lead to severe urogenital complications, including fistula and obstructive uropathy. This case highlights the critical importance of patient education regarding the need for regular pessary care and follow-up. Clinical Significance: Clinicians should maintain a high index of suspicion for an incarcerated pessary in elderly women presenting with chronic vaginal discharge, bleeding, or new-onset urinary incontinence, even if the patient does not recall having one. Imaging, such as a CECT urogram, is invaluable in diagnosing associated complications like fistulas and planning surgical management.