Vesicouterine Fistula Research Articles

Vesicouterina fistula: Youssef's syndrome

Vesico-uterin fistula is a rare type of fistulas and can be diagnosed frequently after surgery. First described by Youssef in 1957. Clasically findings are; cyclic haematuria without urinary incontinence and secondary amenorrhea. The patient was referred to our clinic for cyclic hematuria and she was diagnosed with vesicouterine fistula by radiological imaging methods and a cystoscopy procedure. Being a rare occurrence, this case was reported with a discussion of the relevant literature.

Laparoscopic Repair of Intrapartum Concomitant Bladder and Uterine Rupture

A 38 y/o pregnant woman, G2P1, with unscarred uterus (no previous uterine surgery),vaginally delivered her 2nd baby in a seemed smooth course. But in the postpartum period, PPH and gross hematuria were noted. Concomitant bladder and uteirne rupture were noted. Laparoscopic intervention was performed, to repair the bladder and uteirne laceration hole, preventing the future formation of vesico-uterine fistula. Baby OG tubes were introduced to catheterized bilateral ureters, because the bladder laceration wound was so closed to trigone area. Both uterine wall and bladder wall were successsfully repaired under laparoscopic surgery. Concomitant bladder and uterine rupture in an unscarred multi-parous uterus is extremely rare. The technical tpis for safe repair of the bladder and uterine laceration wound will be demonstrated in this video.

Conservative management of placenta percreta: a stepwise approach

To describe a modified surgical approach in the form of stepwise cesarean section in placenta percreta. We conducted a prospective observational study. A total of 71 patients with placenta percreta were subjected to the new stepwise surgical approach and uterine repair at the time of cesarean delivery. The procedure was successful in controlling the bleeding and preserving the patient's uterus in 65 (91.5%) women. Ten patients (14.1%) had urinary tract complications, nine (90%) were managed during cesarean section and one presented late in the form of vesicouterine fistula. A stepwise cesarean section is safe and effective procedure that can be applied in placenta percreta.

Diagnosis, treatment and need for hysterectomy in management of postcaesarean section vesicouterine fistula

Objective.The aims of this study were to report the diagnosis, treatment and functional consequences of postcaesarean section vesicouterine fistula (VUF), and to investigate the need for hysterectomy. Material and methods. The study included 22 cases with VUF after caesarean section (mean age 30.5 years) between 1999 and September 2012. Total urinary incontinence was found in seven women, occasional incontinence in 15 and cyclic haematuria in 17. VUF was diagnosed by ascending cystography in 14 patients and by computed tomography/magnetic resonance imaging in six. Cystoscopy revealed VUF in all women. VUF repair was conducted by a transabdominal approach. The bladder was opened, the fistula was defined, a circumferential bladder incision was made around the fistula and the fistulous tract was excised. The uterine rent and bladder were closed with omentum interposition. Results.Mean follow-up was 2.8 years (range 0.5–7 years). The repair was successful in all women. Hysterectomy was needed in only one case with dysfunctional uterine bleeding and an enlarged uterus. The incontinence disappeared in all cases. The menstrual cycle became regular after a mean of 5 months in all women who retained their uterus. Five women became pregnant and had a successful delivery after 2–3 years. All women were able to have sexual intercourse after 2 weeks. Conclusions.Cystoscopy was the mainstay of diagnosis of VUF in the current study. Imaging was not able to show very small fistulae. Unless otherwise indicated, there is no need to remove the uterus even if the fistula is large. Although the repair is challenging, it was successful in all cases and pregnancy is possible after repair.

Vesicouterine fistula: Youssef's syndrome

Vesicouterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during Caesarean section (83%–93% of cases)1–3 especially emergency Caesarean section. Youssef's syndrome classically presents as a triad of cyclical hematuria, amenorrhea and urinary continence, that is, there is no vaginal leakage of urine.3

Vesicouterine fistula presenting with urinary incontinence 30 years after primary Cesarean: Case report and review of the literature

A vesicouterine fistula is an abnormal communication between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be applied in some cases, but surgery is the definitive treatment. We present a 55-year-old woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence 30 years later. Methylene blue dye test was performed and drainage of urine dyed with methylene blue through the uterine cervix was observed. Diagnosis was confirmed with magnetic resonance imaging. Total abdominal hysterectomy and bilateral oophorectomy was performed and the bladder wall was sutured in a double layer with 2/0 polyglycolic suture. No complications developed and the patient did not suffer from any urinary incontinence afterwards. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section; diagnostic tests and, if necessary, appropriate surgery should be performed.

A Case of Vesicouterine Fistula: Unwanted Medical Anomaly but Consequentiality of Most-Wanted Medical Intervention ‘Caesarean Section’

Vesicouterine fistula is a rare entity, with unique presentation of cyclical haematuria, amenorrhoea, absence of urinary incontinence (Youssef syndrome). A 35 year old female patient, P2L2 with 2 previous LSCS presented with cyclical haematuria, amenorrhoea, repeated UTI, dating from 11th day of last LSCS. Transabdominal sonography revealed communication between bladder & uterus, confirmed by cystoscopy. At laparotomy fistulous tract delineated and bladder separated from uterus. Hysterectomy and closure of bladder done. Continuous bladder drainage with suprapubic and perurethral foleys catheters maintained. Postoperative period was uneventful. Cystoscopy during followup revealed healthy scar. Vesicouterine fistula is an avoidable complication of LSCS which can be prevented by sound surgical technique.

Youssef's Syndrome

ABSTRACT Vesicouterine fistula (Youssef's syndrome), a rare complication of cesarean section is presented. A 35-year-old female had vesicouterine fistula with symptoms of apparent amenorrhea, cyclic hematuria and meconuria following cesarean section. The patient was treated by abdominal hysterectomy and the fistula tract was repaired. How to cite this article Nath PK, Samal M, Pradhan K, Mohanta C, Mahapatra S. Youssef's Syndrome. J South Asian Feder Menopause Soc 2014;2(2):113-114.

A retrovesical approach for the laparoscopic repair of vesicouterine fistulas

ObjectiveTo report the initial experience with laparoscopic repair of vesicouterine fistulas (VUFs) at Shiraz University of Medical Sciences, Shiraz, Iran. MethodsBetween June 2012 and February 2013, 2 patients with a history of multiple cesarean deliveries had a diagnosis of VUF confirmed by cystography and cystoscopy. The fistulas were repaired laparoscopically via a retrovesical approach to minimize manipulation of the bladder. ResultsThe operative times were 160minutes and 180minutes. Excellent laparoscopic visualization and magnification together with the presence of a catheter in the fistula tract allowed meticulous dissection in the retrovesical space between the bladder and the uterus, and resection of the fistula tract with minimal manipulation of the bladder, obviating the need for a large cystotomy. A postoperative cystogram at 4weeks showed complete resolution of the VUF in both patients. There was no recurrence of the fistula and the patients remained symptom-free during the follow-up period. ConclusionLaparoscopic VUF repair with a retrovesical approach is an effective technique with successful outcome. This approach provides excellent exposure to a poorly accessible area in the retrovesical space. Longer follow-up periods are needed to evaluate the likelihood of VUF recurrence with this technique.

Post Caesarean Vesicouterine Fistula Causing Menouria

Vesicouterine fistula is an uncommon urogenital fistula. The incidence is on the rise because of increasing incidence of Caesarean sections. Cyclical Haematuria 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 Post caesarean section Vesicouterine fistula following 2 Caesarean sections. This was successfully managed by laparotomy with repair of fistulous tract in bladder wall and Total Abdominal Hysterectomy for multiple Fibroid uterus done. Menouria is a rare event in Gynecology and one should always keep this possibility in mind when there is cyclical haematuria. A 42 year old Bangladeshi woman was hospitalized with complaints of menorrhagia, lower abdominal pain for last 8 years, cyclical hematuria for last 20 years. She was mildly anemic, haemodynamically stable and regularly menstruating women. The primary Ultrasound scans suggested multiple fibroid with cystic ovary in left side. Cystoscopy was done and findings are a fistulous opening in the bladder measuring around 7mm in size. It was supratrigonal in position. The patient had no history of Endometriosis, Pelvic irradiation therapy, Inflammatory disease, Trauma or Malignancy. Initially there was dilemma in her diagnosis and the patient was diagnosed as a case of bladder Endometriosis besides fibroid uterus. So surgery was planned and Total Abdominal Hysterectomy & bilateral salphingo-oophorectomy done. There was a fistula about 3cm × 2cm in the lower part of the body of uterus connecting with the base of Bladder. Fistula repaired after dissection, patient follow up done and catheter removed after 14 days without any complications. Vesicouterine fistula can be prevented if care is taken to separate the bladder from the uterus during repeat Caesarean sections. DOI: http://dx.doi.org/10.3329/medtoday.v25i1.16072 Medicine Today 2013 Vol.25(1): 46-48

Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience

To present for the fist time in literature laparoendoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula (VUF) and to compare this with conventional laparoscopic repair. Eleven females with VUF were included; of them, six had conventional laparoscopic repair where 5 ports were used, while five females had LESS repair. Additional 5-mm port was inserted during suturing in LESS group and both straight and pre-bent instruments were used. Fistulous tract was excised; then, uterine rent was closed through single figure of eight suture, while urinary bladder was closed in two layers; then, an omental flap was interposed in between. Sutures were done using 3/0 vicryl. Urinary bladder was drained for 3 weeks through uretheral catheter. No conversion to open surgery in both groups or from LESS to conventional repair. Blood loss in conventional laparoscopic and LESS repair was 95 ± 18 and 86 ± 15 c.c., respectively. No complications were reported in both groups. Operative time for conventional laparoscopic and LESS repair was 149 ± 18 and 144 ± 16 min, respectively. Postoperative hospital stay was 3.1 ± 0.8 and 2 days for both groups, respectively. At follow-up period of 23.6 ± 8.2 and 13.4 ± 1.8 months for both groups, respectively, all were cured. Both conventional laparoscopic and LESS extravesical repair of VUF are effective and reproducible and they follow the same principles of open surgical repair. However, LESS repair of VUF seems to be less morbid than conventional laparoscopic repair.

Early versus delayed repair of vesicouterine fistula

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.

Sonographic appearance of Youssef’s syndrome: A case report and literature review

Vesico-vaginal fistula is still a major problem in the developing world, in particularNigeria. Vesico-uterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than previously thought. We report a case of Mrs U.B. a 28-year-old P2+0 with one living child, who presented with a history of 20 amenorrhea and infertility of 8 years duration. She had caesarean section to relieve an obstructed labor with macerated stillbirth in her last pregnancy. As part of her routine investigation for 20 amenorrhea and infertility, a request for ultrasound scan was made. Ultrasound pictures are presented and discussed. Standard diagnostic investigations for Youssef’s syndrome are by cystoscopy, intravenous urogram and or hysterosalpingography, sonodiagnosis (sonohysterography) is primarily not resorted. We recommend as a standard investigation tool, Ultrasound scan (Sonodiagnosis) for all patients with Vesicovaginal fistula.

Uroperitoneum after Caesarean Section

Intraoperative injuries of the bladder and the attendant vesicouterine and vesicovaginal fistulas formation are reported as rare events, but the rapid increase in the number of caesarean sections has contributed to the emergence of these complications. Early recognition of these complications makes them much easier to deal with, while simple measures intraoperatively can ensure that these complications will not escape attention. We present our rare case of uroperitoneum after cesarean section, the way of diagnosis and treatment, and due to this incident we review in detail the existing literature on the topic.

Bladder Injury during Cesarean Section

Bladder injury during cesarean section is associated with significant morbidity. It can lead to prolonged operative time, urinary tract infection and formation of vesico-uterine or vesico-vaginal fistula. Post cesarean pregnancy, presence of abdominal and or bladder adhesions, emergency cesarean section, placenta previa and/or accrete/ increta/percreta, all are significant risk factors for bladder injury during cesarean section. Immediate repair of the bladder injury always yield better result. But the availability of an urologist is not always certain. The obstetrician should better be well conversant with the bladder repair, which is relatively simple technique and can manage the situation effectively.

Fetus in bladder

This is the first reported case of vesicouterine fistula presenting with a fully formed dead fetus in the urinary bladder.

Urogenital fistula in a Saudi Arabian referral center

To review all cases of genitourinary fistula, their causes, management and outcome. A retrospective chart review of all fistula cases referred to the Urogynecology Department, King Fahad Medical City, Riyadh, Saudi Arabia, from January 2005 to December 2011. Sixteen genitourinary fistula cases were identified; nine (56 %) cases of vesicovaginal fistula, four (25 %) cases of vesicouterine fistula, and three (19 %) cases of vesicocervical fistula. Mean age was 41 (29-61) and mean parity was 7.4 (2-15). Out of the 16 cases, 12 (75 %) had obstetrical surgical complications, of which 8 (50 %) had complications of cesarean sections. Twelve of 15 cases (80 %) were cured after primary surgical repair, 2 (13 %) after secondary repair and 1 after tertiary repair. One case was cured after conservative management. Most of the genitourinary fistulae were of iatrogenic obstetric causes, mainly cesarean section with none of the cases due to obstructed labor unlike fistulae in developing countries or developed countries fistulae (iatrogenic gynecologic origin).

Successful Pregnancy Following Repair of Vesicouterine Fistula Following Repeat Caesarean Section: A Case Report

A lady, para 2, both delivered by caesarean section for prolonged labour, presented with the complaints of menouria and infertility for 3 years following her last caesarean section. She had history of haematuria during menstruation and her menstrual flow is scanty. Her first baby was female and alive, but her second baby was stillborn following prolonged and obstructed labour. This has been continuously blamed by family and others for happening that events. Her fistula was confirmed by ultrasound scan, histerography and cystoscopy. The vesicouterine fistula was treated by local repair with omental patch through transperitoneal approach. Pregnancy following one year of successful repair has turned her from miserable to happiness in life.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11030 BSMMU J 2012; 5(1):76-78

Robot-Assisted Laparoscopic Repair of Rare Post—Cesarean Section Vesicocervical and Vesicouterine Fistula: A Case Series of a Novel Technique

To present experience with robotic repair of complex vesicouterine fistula (VUF) and vesicocervical fistula (VCF) in 3 patients and to describe technique of repair with 18-months follow-up. Three patients were diagnosed with VUF or VCF. Two patients had prior history of lower segment cesarean section complicated by bladder injury and the third had difficult labor with vaginal birth after previous cesarean section. Preoperative diagnosis of VUF/VCF was based on classical history, cystoscopy, and imaging studies. All patients underwent pure robotic repair of fistula. The steps of the technique of repair include cystoscopy, bilateral temporary ureteral catheterization, placement of ports, adhesiolysis, separation of bladder and uterus or cervix, closure of bladder and uterus or cervix and omental interposition. Robotic repair was successful in all patients. There were no intraoperative and postoperative complications. All patients were ambulatory on day 1 and were discharged on day 2. Foley catheter was removed after 2 weeks and all patients were followed over 18 months. This technique demonstrates robotic repair of rare VCF and VUF performed safely and effectively. The robotic assistance helped in complex dissection and reconstructive steps. This approach is an excellent minimally invasive alternative at centers with robotic technology because these fistulae cannot be repaired vaginally. Experience of the team is important in managing such cases.

A cervix penetrating the posterior bladder wall: case report

Clinical manifestations of vesicouterine fistulas, a rare complication of cesarean section, include amenorrhea and cyclic hematuria (menouria) without urinary incontinence, a triad collectively known as "Youssef's syndrome." Fistulas affecting the uterus usually reside above the isthmus or at the cervix and have a distinct morphology composed of granulation tissue, chronic inflammatory cells, and fibrous tissue. We present a case of Youssef's syndrome where the patient's entire cervix penetrated into the posterior bladder wall rather than the two organs connecting via a discrete fistulous tract.