Repair of vesico‐uterine fistula with the O'Conor technique

Abstract

A 40-year-old woman, gravida 6, para 6, had four normal vaginal deliveries. Following her last cesarean, bleeding into the urethral catheter had been observed for 24 h. Hematuria continued for 3 months, and cystography detected a fistula, as the injected contrast medium filled the uterine cavity through the fistula (Fig. 1). The fistula, approximately 20 mm in diameter and 10 mm in length, was detected inthe posterior bladder wall; it had a connection with theanterior uterine wall and also involved the isthmus. At surgery, a 4F urethral catheter was inserted confidently, followed by bisection of the bladder to the level of the fistula (Fig. 2). A complete excision of the fistula tract was performed. Preperitoneal fat tissue was replaced between the uterus and bladder. The urethral catheter was removed onthe seventh postoperative day, and the patient was discharged symptom free. The filling of the uterine cavity by the contrast medium in cystography. View of the vesico-uterine fistula intraoperatively. A vesico-uterine fistula is a rare event, occurring as a complication after cesarean section, curettage and delivery by forceps (1,2). The patient had been urethrally catheterized, which confirmed the hematuria after the last cesarean section, and it has been observed that catheterization after cesarean delivery may suppress the symptomatology. Surgical treatment was performed, using the transabdominal technique for repair of the vesicovaginal fistula, but did not include a hysterectomy. The earliest experience in this condition was reported by O'Conor for abdominal transvesical repair of a vesicovaginal fistula (3). We believe this to be the first reported case of such a vesico-uterine fistula, especially a large one, repaired as a vesicovaginal fistula.