Unveiling Pandora\'s Box: A Rare Case of Post-traumatic Cyclical Hematuria Masquerading as a Congenital Urethrovaginal Fistula

Background: Post-traumatic cyclical hematuria is a rare and often misdiagnosed condition that can mimic congenital anomalies like urethrovaginal fistula, leading to diagnostic confusion.Case presentation: We report a rare case of a 25-year-old woman with a 7-year history of primary infertility and cyclical hematuria.She experienced cyclical passage of blood through the urethra, along with a thin urinary stream, prolonged micturition, and post-void residual expression from the vaginal pouch area.Notably, there was no dyspareunia or difficulty with sexual activity.A detailed history revealed childhood perineal trauma that had been conservatively managed and overlooked during earlier evaluations.Initially presumed to be a congenital urethrovaginal fistula (CUVF), comprehensive imaging and cystoscopy confirmed a post-traumatic fistulous tract.Conclusion: This case highlights the importance of thorough history-taking and tailored diagnostic workup in cyclical hematuria.Post-traumatic causes must be considered, even when the clinical presentation closely mimics congenital anomalies-a true diagnostic Pandora's Box.