Simultaneous Ureterovaginal and Rectovaginal Fistulas Caused by a Cube Pessary: A Case Report

ABSTRACT Introduction We present a case of simultaneous ureterovaginal and rectovaginal fistulas caused by continuous placement of a cube pessary without daily removal, successfully managed through a multidisciplinary approach. Case Presentation An 84‐year‐old female managed with a cube pessary presented with hematochezia. Initial imaging revealed simultaneous pessary penetration into the rectum and right ureterovesical junction. A previous hospital first performed a sigmoid colostomy and an unsuccessful transvaginal rectovaginal fistula closure. Following this, a ureteral stent was placed for the ureterovaginal fistula, but it also failed to close due to extensive tissue defects. She was referred to our hospital, where a multidisciplinary surgery incorporating retroperitoneal extravesical ureteroneocystostomy, transvaginal fistula closure, and anterior colporrhaphy was performed. Conclusion Cube pessaries require daily self‐management, and continuous placement in elderly patients can lead to severe ischemic complications. Multidisciplinary surgical reconstruction is crucial to preserve renal function and restore quality of life.