The most common cause is lower segment cesarean section. The type of surgical approach depends on the fistula location, other health conditions, and size of the fistula. This video nicely depicts the laparoscopic repair of a vesicouterine fistula. The disease presented with vaginal urinary leakage,cyclic hematuria and amenorrhea. The major risk factor is a previous cesarean section, which explains the growing. Vesicouterine fistulas following cesarean section report on a. Vesicouterine fistula, a rare cause of genitourinary fistula. Pdf iud induced vesicouterine fistula and urinary bladder. Vesicouterine fistula vuf represents a rare urogenital complication. Vesicouterine fistula after a previous low vertical. The increasing rate of cesarean sections is associated with a growing number of cases reported in medical literature. When a low vesicouterine fistula is present, ct after iv contrast injection is a good method to show the fistula, but a high pressure in the bladder may be necessary. Using transabdominal approach, fistula was repaired through infraumbilical incision. Intrauterine device induced vesicouterine fistula and urinary bladder stone.
The objective is to present a case with vesicouterine fistula after cesarean section. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. They may be associated with endom etriosis 4 as in our fig. Vesicouterine fistula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and. Different therapeutical approaches that include conservative treatment, fulguration, hormonal therapy and open, laparoscopic or robotic surgeries have been mentioned in the. Consider the risk of vesicouterine fistula in the event of intermittent fluid vaginal discharge after a cesarean section. These qualities are advantageous in vesicouterine fistula repair. View the article pdf and any associated supplements and figures for a period of 48 hours. Vesicouterine fistulae vuf comprise 29% of all cases of urogenital fistulae. Our patient was managed by laparoscopic transperitoneal fistula disconnection and closure. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep enough to reach another organ or the skin.
Vesicovaginal fistulae vvf remain one of the most challenging problems in modern female urology. A vesicouterine fistula is an abnormal communication between the bladder and the uterus. Vesicouterine fistulae account for ito 4% genitourinaiy fistulae 1. Pdf vesicovaginal fistula vvf is an abnormal communication between the bladder and the vagina. Vesicouterine fistula after a previous low vertical cesarean section delee incision. Although the indications for abdominal repair of vesicovaginal fistula are somewhat controversial, certain conditions involving the bladder are best approached via an. Afterwards, through transperitoneal route, fistula tract localized on the anterior aspect of the uterus, between corpus, and cervix was accessed figure 2. Previous research has described a woman of reproductive age who presented with a vesicouterine fistula vuf of 20 months duration. The most common cause of this syndrome is trauma during a cesarean section. Vesicouterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during caesarean section 83%93% of cases especially emergency caesarean section. Vesicouterine fistula without vaginal leakage of urine, cyclic hematuria and amenorrhea is a rare condition, identified as youssefs syndrome. Frontiers consider the risk of vesicouterine fistula in the.
In conclusion, helical ct appears as a valuable tool in depicting a vesicouterine fistula. There are multiple ways to investigate vuf and several examinations may be required to confirm the diagnosis. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. A search of the earlier medical literature was by crossreferencing and is likely to be less complete than the. Although laparoscopy provides better visualization through magnification, this technique is. The symptoms are menouria and urinary incontinence. The treatment of genitourinary fistulae with robotic assistance con. The accurate and early diagnosis of vuf can be difficult. Vesicouterine fistula after uterine artery embolization. Lower urinary tract fistulas can communicate with the vagina or the uterus fig.
The proportion of repeat cesarean section resulting in a fistula was significantly increased 58. Oct 17, 2017 vesicouterine fistula vuf represents 29% of all urogenital fistulae. Vesicouterine fistulae resulted following cesarean. Vesicouterine fistula twenty years following brachytherapy. The fistula repair surgeries were uneventful and the patients had an unremarkable recovery. A vesicouterine fistula is a rare presentation in the context of an advanced health care system. In developed countries, most cases occur as a complication of cesarean section, whereas in developing countries, vuf is mainly a complication following. Patients usually experience urinary incontinence intermittent or continuous which may be associated with hematuria.
A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. Discussion most cases of vesicouterine fistulas occur after low cesarean delivery 2, 3. Although fistulas carry a potential risk of recurrence, for pregnant women who had undergone fistula repair, delivery by csection has been recommended. After cesarean vesicouterine fistula youssef syndrome with. An easy and feasible diagnostic method of vesicouterine fistula is sonohysterography. This is the first case report of a vesicouterine fistula that closed spontaneously. Vesicouterine fistula vuf as a rare urogenital complication. Structural arrangement of vesicouterine fistula revisited. It is considered to be the least common type of urogenital fistulas. Nov 16, 2017 vesicouterine fistula is a rare complication of cesarean section.
We present a case of vesicouterine fistula and extrusion of a degenerating leiomyoma into the bladder after uae, necessitating hysterectomy and partial cystectomy for repair. A vesicovaginal fistula vvf is an abnormal fistulous. A vesicouterine fistula was diagnosed 2 months later. Vesicovaginal fistula vvf is an abnormal fistulous tract. Type ii is characterized by the dual flow of menstrual blood, i. Vesicouterine definition of vesicouterine by medical dictionary. Vesicouterine fistula article about vesicouterine fistula. Repair of abnormal drainage tract from bladder into the vagina and removal of the uterus. Vesicouterine fistulae are uncommon and have been estimated to account for only 1% to 4% of all genitourinary fistulae. Only 8 cases of vesicouterine fistula have been described in the world literature to date, probably because this condition is almost always a complication of the lowersegment type of cesarean section which has been popular in only the past 25 years.
Iatrogenic reasons have been shown to be the most prominent cause, with lower segment caesarean section accounting for approximately twothirds of the cases. Repair of a vesicouterine fistula following cesarean section. When a high vesicouterine fistula is suspected, it is best shown on hysterography. The vuf was lined with a metaplastic glandular epithelium containing. Vesicouterine fistula is a rare complication of cesarean section due to a transverse incision into the lower segment. Although rare, a vesicouterine fistula can occur as a complication of vaginal delivery in patients with a history of cesarean delivery. Vesicouterine fistula presenting with urinary incontinence 30 years after primary cesarean. Vesicouterine fistula is responsible for the symptoms of youssef syndrome. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep. Despite the advantages of laparoscopy, there are few case reports showing its feasibility in the management of this rare entity.
A 27yearold female patient, g2p2, was admitted to hospital with the complaint of severe crampy pelvic pain and dysuria during micturition without any incontinence. Youssefs syndrome article pdf available in medical journal armed forces india 71suppl 1 january 2014 with 21 reads how we measure reads. Intravenous pyelogram demonstrated normal kidneys and ureters. They include bladder decompression with an indwelling catheter and medical management to induce.
This procedure was asso ciated with minimal blood loss and morbidity, and the patients hospital stay vvas less than 24 hours. Abdominal repair of vesicovaginal and vesicouterine fistula. Vesicouterine fistula is a rare complication of gynecologic surgery. When conservative treatment has failed and leakage of urine continues per vaginum despite good bladder drainage, surgical correction of the fistula becomes. Clinical classification of vesicouterine fistula sciencedirect. Pdf on jan 1, 2011, latika sahu published chapter21 vesicovaginal. One patient had an early surgical repair because of intractable pain and the other patient because of the large size of the fistula.
Spontaneous closure of vesicouterine fistula following. Laparoscopic repair of vesicouterine fistulasingh et al urology journal vol 8 no 2 spring 2011 151 treatment of choice in such a case is vuf disconnection and closure of the bladder and uterine fistulous openings with interposition graft. Vesico vaginal fistula vvf is a common occurrence in developed countries with an annual incidence of 50,000100,000 cases and. The management of genitourinary fistula in the third millennium. A cystogram 4 months after injury demonstrated a small fistulous tract from the posterior superior portion of the bladder to the uterine cavity. Patient morbidity in this case possibly could have been avoided with earlier diagnosis and access to care. Vesicouterine fistulas are usually associated with psychological distress and have a negative effect on quality of life.
Treatment of vesicouterine fistula by fulguration sciencedirect. Vesicouterine fistula is an abnormal passageway between the cavities of the bladder and uterus. During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. May 17, 2012 a retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. Vesicouterine fistula vuf is the rarest form of genitourinary fistulas. Download as ppt, pdf, txt or read online from scribd. The aim of this video is to present a case report and to provide a tutorial on the surgical technique of delayed transvaginal repair of a high vesicouterine fistula that developed after cesarean section with manual removal of a morbidly adherent placenta. Excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. The highest incidence concerns young females of reproductive age. Voiding cystometrogram of vesicouterine fistula with mass in bladder. Oftentimes the tissue near the fistula tract has a poor blood supply and may need a graft to help promote healing near the fistula tract.
To ascertain the condition of vesicouterine fistula, a search of the medical literature using the ovid version ovid technologies inc. Vesicouterine fistula how is vesicouterine fistula. Vesicouterine fistulas vuf are the least common type of urogenital fistulas, which is defined as an uncommon communication between the bladder and the uterus or the cervix. After incision of the bladder dome, bladder was opened, and incision was advanced posteriorly up. This report concerns an extremely rare type of fistula, a vesicouterine fistula, in a 59yearold female occurring twenty years following brachytherapy for cervical cancer. Current procedural terminology closure of vesicouterine. To our knowledge, this is the fourth case report of a fetus in the bladder secondary to vesicouterine fistula. Only 5% of patients respond to conservative management, whereas other patients require definitive surgical repair. Vesicouterine and vesicocervical fistulas are rare, accounting for approximately 4% of all urogenital fis tulas. We present 3 cases of vesicouterine fistula with successful surgical repair in which 2 patients had an early repair.
A 40yearold woman presented to our department with urinary incontinence associated to cyclic hematuria and amenorrhea. Menouria a presentation of vesicouterine fistula pages with reference to book, from 159 to 161 shereen zulfiqar bhutta department of obstetrics and gynaecology. The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus. The patient was treated conservatively with foley catheter drainage but failed to respond after 2 months. After cesarean vesicouterine fistula youssef syndrome. Vesicouterine definition of vesicouterine by medical.
Early versus delayed repair of vesicouterine fistula. Uterovesical fistula free download as powerpoint presentation. Youssefs syndrome classically presents as a triad of cyclical hematuria, amenorrhea and urinary continence, that is. Less common causes are radiationinduced and advanced pelvic malignancies such as bladder, rectal, and cervical tumors and their treatment. Vesicouterine fistula twenty years following brachytherapy for cervical cancer article pdf available in scandinavian journal of urology and nephrology 324. This condition is very rare and accounts for 1% to 4% of all urogenital fistulas, including vesicovaginal fistula, ureterovaginal fistula, and urethrovaginal fistula 1, 2. Vesicouterine fistula is a rare type of urogenital fistula. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely emptying the bladder, nocturia and constant leakage of urine for. Grafts can include a womans own tissue or muscle that is placed over the repaired fistula tract.
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