Figure 17c. Urethrovaginal fistulas in four patients. (a) VCUG image shows a small fistula (arrow), which may be difficult to differentiate from a urethral diverticulum. (b) VCUG image shows a larger fistula, which is clearly demonstrated by contrast material in the vagina (arrow). The fistula is complicated by a urethral diverticulum (arrowhead). (c) VCUG image shows a very large fistula that has caused gross disruption of the urethrovaginal wall. (d) Intraoperative photograph shows a Foley catheter in the urethra that is visible from the vagina through the fistulous defect (arrow).