Early versus delayed repair of vesicouterine fistula

Abstract

Vesicouterine fistulas (VUF) are a pathological and uncommonconnection between the uterus and the bladder. Although rare,they are usually related to cesarean section. Nowadays, theirincidence increases because of the increase in Cesarean sections.Patients with VUF may have various clinical presentations. Themain symptoms are urinary incontinence, which may be associatedwith hematuria. Vesicouterine fistulas are usually associated withpsychological distress and have a negative effect on quality of life.The accurate and early diagnosis of VUF can be difficult. There aremultiple ways to investigate VUF and several examinations may berequired to confirm the diagnosis; these examinations may includea cystoscopy, a retrograde cystography, methylene blue test and acomputed tomography scan. We present 3 cases of vesicouterinefistula with successful surgical repair in which 2 patients had anearly repair. One patient had an early surgical repair because ofintractable pain and the other patient because of the large sizeof the fistula. The fistula repair surgeries were uneventful andthe patients had an unremarkable recovery. We report that earlysurgical management is technically feasible without significantlyincreasing the difficulty of the surgery, with an excellent outcomein selected patients.