Abstract
Background: Vesicouterine fistula is a rare type of genital fistula. It is a cause of urinary incontinence in our environment. It usually results from caesarean section. The study was undertaken to document our experience in the management of this condition. Methodology: This is a retrospective study carried out at the National Obstetric Fistula Centre, Abakaliki, Nigeria from January 2013 to October 2015. Records of women with vesicouterine fistula were retrieved. Information on age, parity, predisposing factors, aetiology, presentation, diagnosis, management and outcomes of repair were obtained. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results: Vesicouterine fistula was seen in 13 out of 619 women constituting 2.1% of all genital fistulas. The mean age of the women was 37.4 ± 9.9 years with 53.5% of them between 30-39 years. Of the 12 women who had term pregnancies, 3 (25%) had no previous caesarean section, 4 (33.3%) had 1 previous caesarean section and 5 (41.7%) had 2 previous caesarean sections making previous caesarean section a predisposing factor in 75% of cases. Fistula occurred following caesarean section in 7 women (53.8%), vaginal delivery in 4 (30.8%), exploratory laparotomy due to uterine rupture in 1 (7.7%) and dilatation and curettage in 1 (7.7%). All 4 women whose fistula followed vaginal delivery had previous caesarean section. All the 13 women presented with menouria. Two (15.4%) had menouria only while11 (84.6%) had menouria with urinary incontinence. In 6 women (46.2%), diagnosis was clinical. Hysterosalpingogram was employed in 1 patient. All the women has surgical repair via the retropubic extraperitoneal approach. Fistula was closed in all 13 women. Conclusion: Vesicouterine fistula is uncommon and usually follows caesarean section. Previous caesarean section is an important predisposing factor. It presents commonly as menouria and urinary incontinence. Outcomes of repair are excellent.
Highlights
Vesicouterine fistula implies an abnormal communication between the bladder and the uterus
All the 13 women presented with menouria
Fistula was closed in all 13 women
Summary
Vesicouterine fistula implies an abnormal communication between the bladder and the uterus It is a rare type of genital fistula. Youssef in 1957 described the triad of amenorrhoea, cyclical haematuria (menouria) and urinary continence following lower segment caesarean section as characteristic of vesicouterine fistula [1]. The prevalence is on the rise owing to increasing use of caesarean delivery [3] It can occur following instrumental vaginal deliveries or vaginal birth after previous lower segment caesarean sections [4,5]. Vesicouterine fistula is a rare type of genital fistula It is a cause of urinary incontinence in our environment. The study was undertaken to document our experience in the management of this condition
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