A Study on the Use of Pelvic Floor Ultrasound Combined with Transvaginal Contrast-Enhanced Ultrasound in the Diagnosis and Treatment of Vesicovaginal Fistulas

Abstract

Background and Aims: Vesicovaginal fistulas (VVFs) cause involuntary urinary leakage and require clear delineation of fistula anatomy before repair. This study evaluated pelvic floor ultrasound combined with intracavitary contrast-enhanced ultrasound (IC-CEUS) for identifying and characterising VVFs. Methods: Eight patients with suspected VVF who attended the First Affiliated Hospital of Hebei North University between July 2022 and January 2024 were retrospectively reviewed. Two-dimensional and three-dimensional transperineal pelvic floor ultrasound examinations were performed using an intracavitary volumetric probe. After intravesical injection of diluted ultrasound contrast agent, fistulous passages and their relationships with the bladder neck and ureteral orifices were examined. Imaging findings were compared with cystoscopic and operative observations. Results: Conventional two-dimensional ultrasound showed a fistulous tract in four patients. IC-CEUS demonstrated a single abnormal passage between the bladder and vagina in all eight patients within 5–15 seconds of contrast administration. Five fistulas were low-level and three were high-level. Mean fistula diameters were 7.0 ± 2.2 mm and 4.3 ± 2.1 mm, respectively. Five patients underwent transvaginal repair and three underwent laparoscopic transabdominal repair. Seven repairs were successful, and postoperative ultrasound showed no contrast leakage in these patients. One patient with radiation-induced VVF had an unsuccessful repair. Conclusion: In this small retrospective series, combined ultrasound provided anatomical information consistent with surgical findings and supported preoperative characterisation and postoperative assessment of VVF.