Cyclic Hematuria Research Articles

Radiological diagnosis of vesicouterine fistula: Role of magnetic resonance imaging

To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF). Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed. The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively. In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF.

Successful management of a thick transverse vaginal septum with a vesicovaginal fistula by vaginal expansion and surgery

We present a case of a thick transverse vaginal septum with a vesicovaginal fistula treated with vaginal expansion using dilators, followed by surgery. A 27-year-old woman was admitted to our hospital with vaginal atresia and cyclical hematuria. Urethroscopy and cystography showed a vesicovaginal fistula between the proximal vagina and bladder. The vaginal septum was 4 cm thick. Over a 6-month period, the distal vagina was expanded with the use of dilators and the septum was sufficiently thinned. Reconstruction using a transvaginal and transabdominal approach created a direct anastomosis between the proximal and distal vagina. No vaginal strictures or contractures in the anastomotic region have been observed during the 12 months following surgery. The combination of expansion and subsequent reconstructive surgery for the treatment of a thick transverse vaginal septum with a vesicovaginal fistula was less invasive than alternative surgical approaches and provided the desired outcome.

Les complications urologiques de la chirurgie gynécologique

To analyze the epidemiological, anatomoclinical, surgical and evolutionary aspects of the urological complications of gynecological surgery. It was about a retrospective survey, concerning 81 patients hospitalized in the department of urology of the university hospital, Brazzaville from 2000 to 2008 for urological complications of the gynecological surgery. The epidemiological, diagnostic, surgical and evolutionary parameters have been analyzed. The urological complication of the gynecological surgery has been recovered in 3% of patients hospitalized in urology. The middle age was 37±14.52 years (17 and 74 years). The median was about 36 years. The middle delay of diagnosis was 15 days (0 and 350 days). The revealing clinical signs were: the oligoanuria (n=12), the urinary incontinence (n=57), the lumbar pain (n=9) and the cyclic hematuria (n=2). The surgical interventions in reason were: the Caesarean (n=50), the hysterectomy for fibroma (n=26), the myomectomy (n=3) and the hysterectomy for cancer (n=2). Anatomical lesion were 55 (67.9%) vesicovaginal fistulas, 12 (14.8%) ureteral ligatures, eight (10%) uretero-vaginal fistulas, three (3.7%) vesico-uterine fistulas, two (2.4%) wounds ureteral and one (1.2%) vaginal vesico-fistulas and uretero-vaginal fistulas. The treatment consisted in one termino-terminal ureterorraphia, 20 uretero-vesical reimplantation, 57 cures of vesico-vaginal fistulas and one nephrectomy. The recovery was obtained at 96% of the ureteral lesions and 90% of the vesico-vaginal fistulas. The lesions of the ureteral and the bladder were often met during the gynecological surgery. The treatment requires knowledge of the anatomy of pelvis.

One case of pregnancy and congenital vesicovaginal fistula

To discuss the diagnosis and therapy of congenital vesicovaginal fistula (VVF). We reported 1 case of pregnancy and congenital VVF and summarized the pathogenesis and characters. Congenital VVF is extremely rare and characterised by continuous urinary leakage,cyclical hematuria with severe suprapubic pain. It is always associated with other urinary tract abnormalities, urinary tract infection and stone. The pathogenesis is related with genetic, environment, drugs, radiation and incomplete fusion of mullerian. The diagnosis relies on clinical manifestation and radiological examinations.Surgical resection is the key to treatment. Pregnancy and congenital VVF is extremely rare and always misdiagnosised associated with other urinary tract abnormalities. Early diagnosis and making sure the location, size and relationship with other tissues are important. Reasonable preoperative preparation, surgical and postoperative surgical care are the key for treatment.

Post‐cesarean vesicouterine fistula (Youssef syndrome): Report of two cases

Vesicouterine fistula (VUF) is a rare complication of cesarean section. We present two cases of VUF that were successfully managed by transperitoneal surgical repair. The first case presented with the Youssef classical triad: cyclical hematuria (menouria), amenorrhea and urinary continence, while the second case presented with total urinary incontinence with normal menstruation. In both cases, diagnosis was confirmed by hysterogram and both were managed by transperitoneal surgical repair. The clinical features, etiologic factors, diagnostic procedures and treatment modalities are discussed in relation to the case and others as reported in the literature.

Iatrogenic urethrovaginal fistula with transverse vaginal septum presenting as cyclical hematuria

We present a case of iatrogenic urethrovaginal fistula with transverse vaginal septum. The patient presented with cyclical hematuria and infertility. The vagina was blind-ending. The magnetic resonance imaging (MRI) showed normal uterus with transverse vaginal septum. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula below the internal urethral sphincter. Vaginoplasty and repair of the urethrovaginal fistula was done. The vagina was reconstructed using an amniotic mould. The report emphasizes the importance of MRI and cystoscopy in diagnosing such rare and complex anomalies.

V174 TRANSPERITONEAL EXTRAVESICAL LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2010V174 TRANSPERITONEAL EXTRAVESICAL LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA Aly Abdel-Karim, Ahmed Mosa, Mohamed Hasona, and Salah Elsalmy Aly Abdel-KarimAly Abdel-Karim More articles by this author , Ahmed MosaAhmed Mosa More articles by this author , Mohamed HasonaMohamed Hasona More articles by this author , and Salah ElsalmySalah Elsalmy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To date there are few reports of successful laparoscopic repair of vesicouterine fistula. We present a video that shows the technique of transperitoneal extravesical laparoscopic repair of vesicouterine fistula. METHODS The patient is 29 years female that presented with Youssef, syndrome following her 2nd cesarean section. Computed tomography (CT) of the abdomen and pelvis and cystoscopy revealed a supratrigonal vesicouterine fistula. The fistula was repaired through laparoscopic transperitoneal extravesical approach using 4 ports. The fistulas tract was identified and completely excised extravesically using sharp dissection. The edge of the bladder was excised at the site of fistulas tract. The urinary bladder was closed in a single layer using 3/0 vicryl continuous suture, while the uterine rent was closed with interrupted 2/0 vicryl suture. An omental flap was interposed between the bladder and the uterus. The urinary bladder was drained by an indwelling urethral catheter for 10 days. RESULTS The operative time was 180 minutes. Blood loss was 50c.c. There were no intraoperative or postoperative complications. Postoperative hospital stay was 2 days. Follow up CT scan of the abdomen and pelvis and cystoscopy 3 months following the repair revealed good healing of the repaired area of the urinary bladder. Clinically, the patient has no cyclic hematuria any more. CONCLUSIONS Transperitoneal extravesical laparoscopic repair of vesicouterine fistula appears to be a safe and effective procedure that adheres to the principles of transabdominal open surgical repair with decreasing morbidity and better cosmoses. However, the technique requires good laparoscopic skills. Alexandria, Egypt© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e70 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aly Abdel-Karim More articles by this author Ahmed Mosa More articles by this author Mohamed Hasona More articles by this author Salah Elsalmy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Síndrome de Youssef y fístulas vesicouterinas

Youssef's syndrome is a rare complication commonly secondary to lower segment caesarean section. It consists of a vesicouterine fistula situated above the isthmus of the uterus. Its symptomatology is analysed, which includes the classical triad of caesarean section, amenorrhoea and cyclic haematuria or menurias in the absence of urinary incontinence, together with its diagnosis and treatment, usually surgical, with excision of its fistulous tract and interposition of an omental pedicle.

Post-Caesarean Vesico-Uterine Fistula: A Rare Entity

Vesicouterine fistula is an uncommon urogenital fistula. The incidence is on the rise because of increasing incidence of cesarean sections. Cyclical hematuria or menouria is an important clinical feature of this fistula which may or may not be associated with urinary incontinence depending on the location of the fistulous tract. We present a case report of vesicouterine fistula following 2 previous cesarean sections. This was successfully managed by cystoscopic fulguration followed by hormonal suppression of menstruation for 3 months. Vesicouteine fistula can be prevented if care is taken to separate the bladder from the uterus during repeat cesarean sections.

Symptomatic urinary problems in female genital tract anomalies

Most of urological abnormalities in urogenital anomalies are asymptomatic and need no special treatment; however, a few patients have critical urinary complaints and surgical corrections are required for them. Unfortunately, these coexisting urinary problems are often neglected and failed to be treated. So, it is necessary to delineate the diagnosis and treatment of similar anomalies. Eight typical patients who had urogenital anomalies with urinary discomfort in our institution were excerpted and reported. In this series, the urinary symptoms ranged from cyclical hematuria and urinary incontinence to infection symptom. The involved urological anatomies were generally categorized into three types: abnormal communication of urogenital tracts, malformation of bladder or ectopic ureter, and anomalies of urethral orifice. Surgical corrections were helpful for most cases. For patients with genitalia anomalies, the coexisting urological defects should be highlighted by our gynecologists, especially when they are symptomatic and require surgical correction.

Laparoscopic Excision of Endometriotic Bladder Nodule and Repair of Cystotomy

Endometriosis involving the bladder is not common. It may present with cyclic hematuria as well as pelvic pain. This may be palpable vaginally, anterior to the cervix. On cystoscopy, there is mucosal edema and nodularity. Occasionally, it can be misdiagnosed as a malignancy on ultrasound due to its irregular appearance. Laparoscopic excision with simultaneous cystoscopic visualization will minimize the risk of cystotomy. Complete excision is recommended to obtain relief of symptoms. CO2 laser is the preferred modality. Ureteral stents may be necessary if the lesion is in close proximity to the ureteric orifices.

Bicornuate uterine horns with complete cervical–vaginal agenesis and congenital vesicouterine fistula

We present a case of bicornuate uterine horns with complete cervico-vaginal agenesis and associated congenital uterovaginal fistula. The patient presented with cyclical hematuria, amenorrhea, and abdominal lump. The vagina was blind-ending. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula on the posterior wall of the urinary bladder. The magnetic resonance imaging (MRI) showed bicornuate uterus and cervical agenesis. Hysterectomy and repair of the uterovesical fistula was done. The vagina was reconstructed using an amniotic mould. The report underlies the importance of MRI in diagnosing complexity of such rare anomalies. It also stresses for the need of hysterectomy if cervicovaginal agenesis is present.

Transverse Vaginal Septum with Congenital Vesical-Vaginal Communication and Cyclical Hematuria

Cyclical hematuria is an unusual presentation of a müllerian fusion anomaly. We report a patient with transverse vaginal septum and menstruation by way of the lower urinary tract because of a vesical-vaginal communication. A defect of vertical fusion, transverse vaginal septum results from failure of canalization of the vaginal plate. Reconstruction using a transvaginal and transabdominal approach created a direct anastomosis between the proximal vaginal segment and the distal vaginal pouch. Previously described cases are reviewed.

Pregnancy in an untreated case of transverse vaginal septum with vesicovaginal fistula

An 18-year-old woman presented with history of cyclic hematuria, abdominal pain, and a mass in the hypogastrium. She was found to have transverse vaginal septum in the lower one-third of her vagina with congenital vesicovaginal fistula (VVF) and a dead fetus of approximately 20 weeks gestation. She underwent vaginotomy and removal of the dead fetus. Vaginal repair of VVF was carried out 3 months later.

POST CAESAREAN VESICOUTERINE FISTULAE – YOUSSEF SYNDROME: OUR EXPERIENCE AND REVIEW OF PUBLISHED WORK

To analyse the incidence, symptomatology, diagnosis and therapeutic aspects of Youssef syndrome (post caesarean vesicouterine fistula), and to review relevant published work. A retrospective study from the urosurgical unit of a tertiary care referral hospital was carried out. In a retrospective analysis of urogenital fistulae over 10 years, we identified 14 patients with uterovesical fistulae, resulting from caesarean section. All the patients were evaluated by history, physical examination, radiological tests and cystoscopy. All patients underwent transperitoneal repair of these fistulae with omental interposition. Results of surgery were evaluated by absence of cyclic haematuria, stoppage of urinary incontinence, and achievement of fertility. A total of 12 patients who had minimum follow up was included in the present study. The results showed that 50% of the fistulae resulted from emergency caesarean operation with 58% of patients presenting after their second caesarean section. The mean age of the patients was 19 years (range 15-29) and mean duration of symptoms was 7 months (range 3-16). Menouria and amenorrhoea were predominant presenting symptoms. The results of surgical treatment were excellent with good continence and resolution of the cyclic haematuria. Three pregnancies (37.5%) which resulted in elective caesarean section were recorded. Vesicouterine fistulae, despite being infrequent, are no longer a rare diagnosis and are most commonly secondary to lower segment caesarean section. With patient history and selected investigations diagnosis is relatively easy. The surgical repair of these fistulae is standard treatment, especially with delayed fistulae with achievement of total continence, and complete resolution of cyclic haematuria. Meticulous practice of obstetric and surgical principles during caesarean section can prevent the formation of these fistulae.

Vesicouterine fistula: a review of eight cases

Eight cases of vesicouterine fistula (VUF) (obstetrical etiology in six cases and inflammatory bowel disease in two) have been treated in the past 14 years. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2-24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.

Gebärmutter-Harnblasenfistel

Uterovesical fistulas belong to the least common types of urogenital fistulas. Although uncommon, they cannot be considered a rarity in view of about 800 published cases in the literature. They are most frequently caused by repeated caesarean sections, which are increasing, and their complications can be expected to increase as well. During the second caesarean section of a 31-year-old woman, the urinary bladder was opened and subsequently closed by a urologic surgeon. In the following weeks and months, the patient suffers from urinary incontinence in response to bladder filling, cyclic hematuria (menouria) and recurrent cystitis. After multiple examinations without establishing a diagnosis, an uterovesical fistula was suggested by cystoscopy and confirmed by cystography. The fistula, which measured 2 cm in diameter, was successfully closed by transperitoneal approach without interposition of omentum. Uterovesical fistulas are to be expected to increase due to an increasing rate of repeated caesarean sections. They can be suggested by their typical symptoms, easily diagnosed by imaging examinations and successfully treated by transperitoneal closure.

Spontaneous abortion through the bladder

Amenorrhea, menouria (cyclical hematuria) and absence of urinary incontinence that characterize the Youssef’s syndrome is the common presentation of vesicouterine fistula. Women with vesicouterine fistulas are generally considered to be sterile . Presented is a case of para 1 who presented with massive hematuria to emergency ward 18 months after cesarean delivery, which posed a diagnostic dilemma.

Conservative management of a traumatic uterovesical fistula (‘Youssef’s syndrome’)

‘Youssef’s syndrome’ is characterised by cyclical haematuria, the absence of vaginal bleeding and complete urinary continence. It is a rare complication of caesarean section when bladder injury occurs and a fistula develops. While operative repair may be required, we describe a case that was managed conservatively and resolved without surgical intervention.

Les fistules vésico-utérines d’origine obstétricale. À propos de 3 cas

Vesico-uterine fistulae (VUF) lead to an abnormal breech between the bladder and the womb. They are responsible for urinary incontinence and/or cyclic hematuria. They are rare and, in most cases, lead to complications following caesarean deliveries. We report observations of 3 vesico-uterine fistulae treated over a 5 years period at university maternity based at Casablanca, Morocco; they all occurred following caesarean deliveries. These patients were consulted for urinary leakage occurring few weeks up to many years following surgical traumatism. Diagnosis was evoked clinically in all cases and confirmed by intravenous urography and/or hysterography. These VUF were successfully treated by simple breech suture at laparotomy. Treatment is very simple and efficient when the diagnosis is made early and fistula simple. Surgery is recommended after medical treatment failure aiming at fistula drainage.