Post hysterectomy urine leaks secondary to urinary fistulae are known and commonly encountered in practice. I present a unique experience with a seemingly common problem.

A 65 year old lady presented to the outpatient department with recent onset of leak per vagina. There was no stress or urge incontinence. She had on and off fever, nausea and was culture positive, treated outisde for UTI. Past history was positive for a laparoscopic hysterectomy and salphingo oophorectomy done 3 months back. A VP shunt for aqueductal stenosis was done 8 years before. She underwent a CT IVU and a collection with suspected communication with the vaginal vault was seen at the terminal end of the VP shunt. A dye test confirmed leak from the shunt and the shunt was removed by the neurosurgery team following which she had no further complaints.

 

While it is common to find post hysterectomy urinary fistulae, presence of unusual symptoms should alert the clinician to possibility of alternate diagnoses outside the realm of urology sometimes. Complete, unbiased evaluation of the patient considering the previous history is important to reach the final diagnosis.