Retrograde Vaginal Methylene Blue Injection for Localization of Complex Urinary Fistulas

Background: Ureterovesical and vesicovaginal fistulae usually are easily diagnosed with standard techniques, including radiology, double-dye test, cystoscopy, and vaginal examination. In a few complex cases, however, the localization of the fistulous orifice may be extremely difficult. Method: We describe a novel technique of retrograde vaginal methylene blue testing that may assist in the proper localization of the fistulous opening. Results: Our experience with one case each of ureterovesical and vesicovaginal fistula easily diagnosed with this method proves its efficacy, simplicity, and safety. Conclusion: This technique should be reserved for cases of urinary fistulae when all standard diagnostic methods have failed.