Vesicouterine Fistula Research Articles

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience

Laparoscopic repair of different female genitourinary fistulae has been recently reported, including both conventional and laparoendoscopic single-site surgery (LESS). We present our 10-year single-center experience of the laparoscopic repair of different types of female genitourinary fistulae. A retrospective analysis of our records over the last 10years was performed. Type of fistula, etiology, laparoscopic approach, operative data, postoperative outcome, and follow-up were recorded. Overall, 46 patients with laparoscopic repair of genitourinary fistulae were reported: 25 had vesicovaginal fistulae (VVF), 14 had vesicouterine fistulae (VUF), and 7 had ureterovaginal fistulae (UVF). Thirty-three patients had conventional laparoscopic repair, whereas 7 VVF and 6 VUF had LESS repair. In all patients with VVF and VUF, extravesical repair was carried out by excising the fistulous tract and closing both the bladder and the vagina or the uterus with interposing tissue in-between. In patients with UVF, extravesical ureteric re-implantation was performed. Mean operative time was 176 ± 25min. Mean blood loss was 105 ± 25 cc. No intraoperative or postoperative complications occurred. None was converted to open surgery. Mean postoperative hospital stay was 3.2 ± 1.2days. After a mean follow-up of 6.3 ± 3.1years, all patients had undergone successful repair, except for one patient with complex VVF. Laparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements.

Spectrum of urologic complications in obstetrics and gynecology: 13 years’ experience from a tertiary referral center

To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free. Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.

Successful Repair of Iatrogenic Cyclical Menouria

Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only (1-4%) of all genitourinary fistulas. It is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment caesarean section. Patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint. Among all vesicouterine fistula 90% are Youseef’s Syndrome the least common of the urogynaecological fistulas. Youseef’s syndrome is characterized by cyclic haematuria (menouria), absence of vaginal bleeding (amenorrhea) and urinary incontinence due to vesicouterine fistula (VUF).TAJ 2017; 30(1): 70-72

Management Of Vesicouterine Fistulae During "Fistulae Surgical Caravan" in Cote D'ivoire

Aims: Describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesico-uterine fistula.
 Methods: This was a case series of 34 patients prospectively collected for descriptive purposes. Theywere treated for Vesico-uterine fistulae during "fistulas surgical caravans" from 1stJanuary 2012 to 31st December 2016.
 Results: Vesico-uterine fistulae represented 2.1% of all treated urogenital fistulae. At the time of fistula occurrence, the average age of the patients was 33.3 years, and the majority were illiterate (88.2%), lived in rural areas and were unemployed (73.5%). All the fistulae were associated to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was a delivery done by caesarean section in 97.7% of cases. Average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The successful first repair rate was 97.1% in 33 patients. The only case of failure was successfully cured using surgical another technique in a second attempt.
 Conclusion: The vesicouterine fistulae were rare, were mostly associated to previous uterus surgical history and the successful rate is almost 100%.

Self Audit as part time Fistula Surgeon

Aims: To determine the outcome of all the patients operated by single surgeon during this period.
 Methods: From 2006 to2017 total of 2870 patients were operated. These included all cases of urinary and fecal incontinences, inclusive of both acquired and congenital disorders like cloacal abnormalities and bladder exstrophy. Total 2460 cases of Vvf were operated out of which around 68% were operated via vaginal route remaining were via abdominal routes. Abdominal approach was also used for all cases of ureteric reimplantation and vesico uterine fistula. Total of 5 cases of fecal incontinence with cloacal presentation, all of them were older than 16 years. There were five cases of untreated cases bladder exstrophy all adult females treated with Mitroffnof procedure and bladder augmentation. Of fecal incontinence there were 340 cases out of which 190 cases were of 4th degree tear all of them were operated in similar manner. Around 210 cases of ureteric injury were treated. 10% of them were amenable to endoscopic intervention while remaining were reimplanted.
 Results: Over all successful closure of fistula was around 95.14%. Unfortunately restoration of continence rate was around 82%. This was mostly because of small capacity of bladder, OAB, Stress Incontinence because of damage to pelvic floor and to the urethra. While overall mortality was 2 patients and these attributed to cardiac causes. Over successive years there is decrease in cases due to obstetrical causes but rise in iatrogenic causes. Though number of cases treated remains same.
 Conclusions: Overall results are good with reasonable results. Though need further input in trainng of surgeon and midwifes for prevention of fistula.
 Keywords: audit, fistula, surgeon

Predictors of Successful Urogenital Fistula Repair and Incidence of Urinary Problems Post Successful Fistula Repair

Objective: Despite the successful fistula repair many patients may continue to complaint of persistence of symptoms in terms of frequency, urgency, urge incontinence and stress incontinence. To evaluate the association of various predictive factors with the outcome of surgical repair of urogenital fistula and todetermine the incidence and association of urinary problems post successful fistula repair.
 Methods: The retrospective analysis was conducted at Maternal Child Health, PIMS, Islamabad. It comprised data related to vesicovaginal fistula repair of patients from January 2008-June 2018. Various modalities were used to determine the underlying cause of these symptoms including patient’s history, examination, ultrasound, urine examination and urodynamic studies.
 Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases.Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) & ureterovaginal (98%) were more successful. Success rate was further decreased with the history of >1repair attempt of vesicovaginal (71.4%) & vesicouterine (66.5%) fistula.
 Among 318 successful fistulas repair patients, 78 (24.5%) had urinary problems post operatively. Out of these 78, 56.4% had stress incontinence, 41% infection and 2.6% urge incontinence.
 Conclusions: Urinary incontinence after fistula repair requires careful evaluation as the successful repair of a urogenital fistula can correct the fistula defect, but it might not make the patient dry.

Management of Vesicouterine Fistulae during "Fistulae Surgical Caravan" in Cote D'ivoire

Aims : To describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesico-uterine fistula.
 Methods : This was a case series of 34 patients prospectively collected for descriptive purposes. They were treated for Vesico-uterine fistulae during "fistulas surgical caravans" from 1st January 2012 to 31st December 2016.
 Results :Vesico-uterine fistulae represented 2.1% of all treated urogenital fistulae. At the time of fistula occurrence, the average age of the patients was 33.3 years, and the majority were illiterate (88.2%), lived in rural areas and were unemployed (73.5%). All the fistulae were associated to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was a delivery done by caesarean section in 97.7% of cases. Average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The successful first repair rate was 97.1% in 33 patients. The only case of failure was successfully cured using surgical another technique in a second attempt.
 Conclusion: The vesicouterine fistulae were rare, were mostly associated to previous uterus surgical history and the successful rate is almost 100%.

Incidence of Urinary Problems Post Successful Fistula Repair

Aims: The aim was to determine the incidence and association of urinary problems post successful fistula repair.
 Methods: The retrospective analysis was conducted at Maternal Child Health Pakistan Institute of Medical Sciences, Islamabad, and comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Various modalities were used to determine the underlying cause of these symptoms including patient’s history, examination, ultrasound, urine examination and urodynamic studies. Statistical analysis of the record was done using SPSS 21 software.
 Results: Among total 318 successful fistulas repair patients, 78 (24.5%) had urinary problems post operatively. Out of these 78, 56.4% had stress incontinence, 41% infection and 2.6% urge incontinence.13.6% of the stress incontinence was due to sphincter weakness. Urge incontinence was found to be due to detrusor instability. These post-operative urinary complaints were significantly associated with the repair of vesicovaginal (31.3%), urethral (23.1%) and vesicouterine (15.7%) fistula compared to those involving ureter(p 0.04). No significant association was found between the incidence of post-operative urinary complaints and previous history of surgical repair, parity, fistula size and duration of fistula.
 Conclusions: Urinary incontinence after fistula repair requires careful evaluation as the successful repair of a urogenital fistula can correct the fistula defect, but it might not make the patient dry. Moreover, performing further continence surgery may exacerbate the condition in some cases.

Success Rate of Urogenital Fistula Repair and Predictors of Success-An Audit of Ten Years Data

Aims: To evaluate the association of various predictive factors with the outcome of surgical repair of vesicovaginal fistula.
 Methods: The retrospective analysis was conducted at Maternal and Child Health, Pakistan Institute of Medical Sciences, Islamabad, and it comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Statistical analysis of the record was done using SPSS 21 software.
 Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases. There were no significant differences in fistula duration (p0.4), size of fistula (p 0.34) and accessibility (p0.5) between successful and unsuccessful group. However, we found the association between the type of fistula and history of previous repair attempts with the success of fistula repair. Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) and ureterovaginal (98%) were more successful as compared to repair with the history of 1 previous attempt (90.3%, 83.3%, 66.6% and 75% respectively). Success rate was found to further decrease with the history of more than one repair attempt of vesicovaginal (71.4%) and vesicouterine (66.5%) fistula. Further, successful fistula repair in women was also found to be significantly associated with parity less than 4 (p 0.038).
 Conclusion: Despite the higher success rate of urogenital fistula repair, it’s important to refer the urogenital fistula patients timely to specialized fistula centres in order to achieve best results.

65 - Successful delayed surgical repair of vesicouterine fistula (VUF): Case presentation and review of current trends

65 - Successful delayed surgical repair of vesicouterine fistula (VUF): Case presentation and review of current trends

Successful removal of an intrauterine device perforating the uterus and the bladder with the aid of a transurethral nephroscope

An IUD perforating the uterus and bladder and creating a nidus for stone formation is a rare complication. We aim to demonstrate with a video a novel surgical technique that involves transcervically extracting a perforating IUD with a transurethral nephroscope after removal of the bladder stone on the IUD. A 57-year-old woman was referred to our department 4months ago following a 2-year history of suprapubic pain at the end of urination. Ultrasound and X-ray examination confirmed an IUD perforating the uterus and the bladder. The patient underwent transurethral holmium laser lithotripsy and transcervical removal of the IUD with the aid of a transurethral nephroscope. The stone on the perforating ectopic IUD was successfully removed and the IUD was extracted without complications. This video demonstrates a rare case of an IUD that perforated both the bladder and the uterine walls and created a nidus for stone formation in the bladder. The surgical technique involved in removing the stone and extracting the IUD is a new approach to treating this problem. It is suspected that this specific surgical intervention may also help to minimize the formation of a larger vesico-uterine fistula by decreasing the extent of trauma potentially created when extracting the IUD. However, this supposition merits further study.

Congenital vesicouterine fistulas-A PRISMA-compliant systematic review.

Vesicouterine fistulas (VUFs) are infrequent abnormal connections between the bladder and the uterine cavity or cervical canal, being mainly sequelae of repeat Cesarean sections. Exceedingly rare are congenital VUFs. This is a systematic review of available world data aimed to characterize congenital VUFs and better understand the mechanism(s) of their formation. The PubMed® database via MEDLINE® search engine was explored from its inception to March 2018. Relevant studies were identified using selected Medical Subject Heading-based terms. This was further supplemented by cross-referencing and handsearching. Retrieved literature was evaluated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. A total of 6561 articles were identified of which 10 were analyzed. Three VUFs accompanied broader syndromes of congenital defects. A lack of patency at the level of the vagina was present in all assessed cases. Unilateral renal agenesis was confirmed in four of eight (50%) verified patients. Hence, unilateral kidney agenesis was related to a lesser degree (P = 0.0186) than vaginal atresia to VUF. The principal features of these fistulas were as follows: partial or complete vaginal atresia resulting in primary amenorrhea, menouria present since menarche, and urinary continence. This review provides the first systematic evidence that congenital VUFs are chiefly associated with concomitant vaginal atresia. The symptomatology of such VUFs is consistent with that of type I acquired fistulas.

MP75-20 LONG-TERM OUTCOMES OF LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA: EXPERIENCE FROM A TERTIARY CARE CENTRE OF NORTHERN INDIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy III1 Apr 2018MP75-20 LONG-TERM OUTCOMES OF LAPAROSCOPIC REPAIR OF VESICOUTERINE FISTULA: EXPERIENCE FROM A TERTIARY CARE CENTRE OF NORTHERN INDIA Vishwajeet Singh, Sunny goel, Seema Mehrotra, and Rahul Janak Sinha Vishwajeet SinghVishwajeet Singh More articles by this author , Sunny goelSunny goel More articles by this author , Seema MehrotraSeema Mehrotra More articles by this author , and Rahul Janak SinhaRahul Janak Sinha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Vesicouterine fistula (VUF) is a rare cause of female genito-urinary fistula. It comprises 1-4% of all urogenital fistulas. Most of these fistulas occur due to lower segment caesarean section (LSCS). The incidence of VUF is increasing because of increasing prevalence of caesarean section. Traditionally, open surgical repair has been the treatment of choice. However, laparoscopic repair of VUF is a minimally invasive technique and few case reports have been published with short term follow up. In the current study, we are presenting our long- term outcomes of laparoscopic repair of VUF METHODS A retrospective analysis of patients was performed who underwent laparoscopic repair of VUF between 2010 and 2017 after approval of Institutional Review Committee. Nine patients had history of LSCS of whom 3 had history of prolonged obstructed labour and 1 patient had history of dilatation and curettage for medical termination of pregnancy. Radiological imaging included ultrasound of kidney, ureter and bladder for all patients and hysterosalpingography (HSG) in 4 patients and contrast enhanced computed tomography scan in all patients. RESULTS The most common presentation was cyclical menstrual bleeding through urine (menouria) in 9 of 10 patients, associated amenorrhea in 7 and vaginal leakage of urine in 3 cases. Median age of the patient was 28.3 years (range, 22-37), and median postoperative follow up was 2.3 years (range, 1 -4). All patients underwent transperitoneal laparoscopic repair of VUF with successful outcomes (Table-1). The mean operating time was 158.7±16.9 min (range, 135-186 min) with a median blood loss of 100 mL (range, 50-210 mL). All patients were advised not to become pregnant for 1 year following laparoscopic repair. Three patients conceived in follow-up and all delivered normal baby by LSCS CONCLUSIONS Laparoscopic repair of VUF is a safe and effective minimally invasive technique with successful pregnancy in long- term follow up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1017 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Vishwajeet Singh More articles by this author Sunny goel More articles by this author Seema Mehrotra More articles by this author Rahul Janak Sinha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Vesicouterine fistula (Youssef's Syndrome): A case report and review of literature

Vesicouterine fistula is a rare urogynecological fistula, usually iatrogenic following lower uterine segment cesarean section. The clinical features of cyclical hematuria, amenorrhea, and urinary continence, Youssef's syndrome, were first reported in the literature in 1957, among patients with vesicouterine fistula. The case reported was a 36-year-old multipara who had two previous lower segment cesarean sections and presented with amenorrhea and menouria. Hysterosalpingography confirmed the diagnosis. The fistula was repaired following the transabdominal surgery. She regained normal vaginal menses.

Obstetrical Fistula: Clinical, Therapeutic and Prognostic Aspects at the Gynecology and Obstetrics Department of Borgou University Hospital Center in Benin

Introduction: Obstetric Fistula (OF) is a tragedy and a public health problem (physical, social, moral and psychological). Objective: To determine the clinical, therapeutic and prognostic aspects of obstetric fistula at CHUD/B-A maternity ward in 2016. Study Method: This is a descriptive, analytic study with prospective data collection from March 07 to December 31, 2016. Patients with obstetric fistula were the study population. Results: A total of 37 patients were treated including 35 operated, the other two not operated for pyuria and bladder calculus after examination under spinal anesthesia. The average age was 36.6 ± 10.5 years with the extremes of 21 years and 65 years. The mean age of onset of Obstetric Fistula (OF) was 28.9 ± 6.5 years. Patients came from southern Benin (51.4%), were married (67.6%), peasant (35.1%) and out of school (81.1%). The types of OF were vesico-vaginal fistula (VVF) (62.2%), urethro-vaginal fistula (24.3%), vesico-uterine fistula (VUF) (5.4%), and uretero-vaginal fistula (2.7%). The fistula site was supra trigonal (54.1%), urethral (18.9%), trigonal (10.8%), vesico-uterine (10.8%), cervical urethral (2.7%), ureteroid vaginal (2.7%). Fistulas were complex (70.3%), complicated (24.3%) and simple (5.4%). The vaginal route was one of the first routes (64.9%). The operative techniques used were CHASSAR MOIR hysterorrhaphy (74.3%). The cure with continence was 68.6%. Conclusion: OF is observed in young women of childbearing age. VVF is the most common. The management is surgical with several operating techniques. Healing is possible. Hence the importance of paying special attention to these patients for their care.

A very rare complication of vesico-uterine fistula following lower segment caesarean section

Introduction Vesico-uterine fistula (VUF) is a recognised but rare complication following lower segment caesarean section with an incidence of less than 4% of all urogenital fistulae. Patients commonly present with urinary incontinence, cyclical haematuria, amenorrhoea, infertility and spontaneous first trimester abortions. Presentation can be immediate or delayed. Case description A 34-year-old lady presents with an eight-day history of continuous urinary leakage, following LSCS. She had the operation due to failure to progress during labour. She was discharged home after 2 days only to re-present. Speculum examination revealed drainage of clear fluid from the vagina. A vesico-vaginal fistula (VVF) was suspected and she underwent intravenous urogram (IVU) and CT abdomen and pelvis. Radiological findings revealed a suspected fistula but its precise anatomy was uncertain, hence a diagnosis was not made. She underwent examination under anaesthesia, cystoscopy, colposcopy and hysteroscopy, which revealed a small defect in the dome of the bladder and further advancement of the scope led to an entry into a second confined space – the uterus. Clearly there was communication between these spaces. A hysteroscopy revealed missing anterior aspect of the cervix, and proximal to this was the fistula. A urinary catheter was inserted and elective laparotomy planned in six weeks to allow for uterine involution. On the day of her operation, the patient reported cessation of urinary leakage and felt there was no significant vaginal discharge. The assumption was that her fistula had closed spontaneously. A formal cystogram was performed showing the presence of contrast within two cavities. Methylene blue dye was instilled into the bladder via the urinary catheter. Blue staining on the cervix end of the tampon confirmed a patent fistula tract. She underwent laparotomy where the bladder was bivalved to separate it from the anterior aspect of the uterus and cervix, the fistulous tract was excised, and the bladder repaired. An omental ‘tongue’ was place as interposition between the uterus and the bladder. Her post-operative recovery was uneventful and she was discharged home. On review 6 weeks post-operatively, she had made a full recovery with no further urinary leakage. Results and Conclusions VUF is an unusual complication of LCSC, and presentation is very variable, from frank urinary leakage to vaginal discharge. What makes it unique is a competent cervix, which closes and allows urine to be trapped in to the uterus. This creates the variability of the intensity of discharge - if at all and other non-specific presentation as previously alluded to. A high index of suspicion is therefore required to make this diagnosis, as cystograms may not necessarily fill the uterus, especially if already involuted. For the same reasons, VUF may present early following caesarean section or as a delayed presentation several years later. Patients may not necessarily present with urinary leakage. Take home message A double ring overlap should be looked for, in cystograms, and lateral views must be obtained. A methylene blue test can be helpful if carefully conducted. A pelvic ‘scopy’ – cystoscopy, hysteroscopy and colposcopy are part of required armamentarium in making a diagnosis. CT and MRI scans could also be employed. Once a diagnosis is made, repairs of VUF is similar to VVF.

Retrospective Analysis of Patients with Genitourinary Fistula

Objective: To present the outcomes of patients treated at a tertiary center for a diagnosis of genitourinary fistula secondary to gynecological and obstetric etiologies.Study Design: In this retrospective study, analysis was made of 18 patients with a diagnosis of genitourinary fistula in a tertiary center between January 2006 and June 2016. Patient data were taken from the archives and patient histories. A record was made of examinations, diagnostic methods such as cystoscopy and fistulography and appropriate medical treatments, demographic data, intraoperative and post-operative complications, duration of hospital stay, surgical operations and types, diameter and location of fistulas.Results: Of the 18 cases, 14 were secondary to obstetric trauma. In 10 of these 14 cases, fistula had developed after difficult vaginal delivery and in four cases, after caesarean section. Four of the 18 cases were secondary to gynecological surgeries, namely hysterectomy and cystocele repairs. Vesicovaginal fistulas were repaired transvaginally while vesicouterine fistulas and bilateral ureterovaginal fistulas were repaired transabdominally. The mean hospital stay was 3.8±1.5 days (2-7 days). Patients were followed up closely in the first 3 months and recurrence developed in only one case.Conclusion: Fistulas secondary to gynecological procedures are uncommon while fistulas secondary to inadequate perineal care, insufficient labor monitoring and difficulties in vaginal delivery techniques are more prevalent in Turkey. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical

Long-term outcome of laparoscopic vesicouterine fistula repair: Experience from a tertiary referral centre.

Vesicouterine fistula (VUF) is an uncommon cause of female genito-urinary fistula. Most of these fistulas are due to lower segment uterine cesarean section (LSCS). Traditionally, open surgical repair has been the traditional treatment. However, laparoscopic repair of VUF is a minimally invasive technique and few case reports have been published with short term follow up. In the present study, we are presenting our long- term outcome of laparoscopic repair of VUF. A retrospective analysis of 8 patients with VUF was performed from 2010 to 2015. Approval of Institutional Review Committee was obtained. All had history of LSCS of whom 3 had history of prolonged obstructed labor. Radiological imaging included ultrasound of kidney, ureter and bladder for all patients and hysterosalphingography in 4 patients and contrast enhanced computed tomography scan in 4 patients. Median age of the patient was 25.5 years (range, 22-32), and median follow up was 2.3 years (range, 1 -4). The most common presentation was cyclical menstrual bleeding through urine (menouria) in all, associated amenorrhea in 6 and vaginal leakage of urine in 2 cases. All patients underwent laparoscopic repair with successful outcomes. The mean operating time was 155±14.5 min (range, 135-186 min) with a median blood loss of 100 mL (range, 50-210 mL). Successful pregnancy was completed in 2 patients and other patients were taking contraceptives. Laparoscopic repair of VUF is a safe and effective minimally invasive technique with successful pregnancy in long- term follow up.

After Cesarean vesicouterine fistula (Youssef Syndrome) with successful conservative management

Vesicouterine fistula without vaginal leakage of urine, cyclic hematuria and amenorrhea is a rare condition, identified as Youssef’s syndrome. The most common cause of this syndrome is trauma during a cesarean section. Different therapeutical approaches that include conservative treatment, fulguration, hormonal therapy and open, laparoscopic or robotic surgeries have been mentioned in the literature. Herein a case in a 37-year-old patient is reported. Conservative treatment with urinary drainage was successful because the fistula was recognized in the immediate postoperative period.

141 - Feasibility and Clinical Outcome of a Novel Surgical Technique in the Laparoscopic Management of Vesicouterine Fistulae

Study Objective: Vesiciuterine fistulas (VUF) are an uncommon occurrence, but this complication is increasing with the rising numbers of cesarean deliveries.