Vesicouterine definition of vesicouterine by medical dictionary. Clinical classification of vesicouterine fistula sciencedirect. Vesicouterine fistula vuf is the rarest form of genitourinary fistulas. Afterwards, through transperitoneal route, fistula tract localized on the anterior aspect of the uterus, between corpus, and cervix was accessed figure 2. Despite the advantages of laparoscopy, there are few case reports showing its feasibility in the management of this rare entity.
Although rare, a vesicouterine fistula can occur as a complication of vaginal delivery in patients with a history of cesarean delivery. Intravenous pyelogram demonstrated normal kidneys and ureters. Vesico vaginal fistula vvf is a common occurrence in developed countries with an annual incidence of 50,000100,000 cases and. Youssefs syndrome classically presents as a triad of cyclical hematuria, amenorrhea and urinary continence, that is.
This is the first case report of a vesicouterine fistula that closed spontaneously. Repair of abnormal drainage tract from bladder into the vagina and removal of the uterus. The patient was treated conservatively with foley catheter drainage but failed to respond after 2 months. The symptoms are menouria and urinary incontinence. The type of surgical approach depends on the fistula location, other health conditions, and size of the fistula. Pdf iud induced vesicouterine fistula and urinary bladder. When conservative treatment has failed and leakage of urine continues per vaginum despite good bladder drainage, surgical correction of the fistula becomes.
Menouria a presentation of vesicouterine fistula pages with reference to book, from 159 to 161 shereen zulfiqar bhutta department of obstetrics and gynaecology. A 40yearold woman presented to our department with urinary incontinence associated to cyclic hematuria and amenorrhea. During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. These qualities are advantageous in vesicouterine fistula repair. Only 8 cases of vesicouterine fistula have been described in the world literature to date, probably because this condition is almost always a complication of the lowersegment type of cesarean section which has been popular in only the past 25 years. Vesicouterine fistulae vuf comprise 29% of all cases of urogenital fistulae. We present a case of vesicouterine fistula and extrusion of a degenerating leiomyoma into the bladder after uae, necessitating hysterectomy and partial cystectomy for repair. Using transabdominal approach, fistula was repaired through infraumbilical incision. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. The highest incidence concerns young females of reproductive age. After cesarean vesicouterine fistula youssef syndrome with. Less common causes are radiationinduced and advanced pelvic malignancies such as bladder, rectal, and cervical tumors and their treatment. Vesicouterine fistula definition of vesicouterine fistula. Spontaneous closure of vesicouterine fistula following.
Uterovesical fistula free download as powerpoint presentation. Vesicouterine fistulae are uncommon and have been estimated to account for only 1% to 4% of all genitourinary fistulae. Vesicouterine fistula is a rare complication of gynecologic surgery. In developed countries, most cases occur as a complication of cesarean section, whereas in developing countries, vuf is mainly a complication following. Voiding cystometrogram of vesicouterine fistula with mass in bladder. A search of the earlier medical literature was by crossreferencing and is likely to be less complete than the. The proportion of repeat cesarean section resulting in a fistula was significantly increased 58. Vesicouterine fistula, a rare cause of genitourinary fistula. An easy and feasible diagnostic method of vesicouterine fistula is sonohysterography. Early versus delayed repair of vesicouterine fistula. The objective is to present a case with vesicouterine fistula after cesarean section. The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus. Vesicouterine definition of vesicouterine by medical.
Although the indications for abdominal repair of vesicovaginal fistula are somewhat controversial, certain conditions involving the bladder are best approached via an. Patients usually experience urinary incontinence intermittent or continuous which may be associated with hematuria. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep. Vesicouterine fistula vuf as a rare urogenital complication.
Consider the risk of vesicouterine fistula in the event of intermittent fluid vaginal discharge after a cesarean section. A vesicouterine fistula was diagnosed 2 months later. When a high vesicouterine fistula is suspected, it is best shown on hysterography. Vesicouterine fistula article about vesicouterine fistula. Vesicouterine fistula after uterine artery embolization. This video nicely depicts the laparoscopic repair of a vesicouterine fistula. Vesicovaginal fistulae vvf remain one of the most challenging problems in modern female urology. After cesarean vesicouterine fistula youssef syndrome.
Although laparoscopy provides better visualization through magnification, this technique is. The treatment of genitourinary fistulae with robotic assistance con. To ascertain the condition of vesicouterine fistula, a search of the medical literature using the ovid version ovid technologies inc. Vesicouterine fistula twenty years following brachytherapy for cervical cancer article pdf available in scandinavian journal of urology and nephrology 324. 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 especially emergency caesarean section. Vesicouterine fistula after a previous low vertical cesarean section delee incision.
Vesicouterine fistula how is vesicouterine fistula. Type ii is characterized by the dual flow of menstrual blood, i. Structural arrangement of vesicouterine fistula revisited. Vesicouterine fistula presenting with urinary incontinence 30 years after primary cesarean. The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. When a low vesicouterine fistula is present, ct after iv contrast injection is a good method to show the fistula, but a high pressure in the bladder may be necessary. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Only 5% of patients respond to conservative management, whereas other patients require definitive surgical repair. They may be associated with endom etriosis 4 as in our fig. Vesicouterine fistula is responsible for the symptoms of youssef syndrome.
Vesicouterine fistulas following cesarean section report on a. The accurate and early diagnosis of vuf can be difficult. Vesicouterine fistula is a rare complication of cesarean section due to a transverse incision into the lower segment. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely emptying the bladder, nocturia and constant leakage of urine for.
Vesicouterine fistula is an abnormal passageway between the cavities of the bladder and uterus. After incision of the bladder dome, bladder was opened, and incision was advanced posteriorly up. Although fistulas carry a potential risk of recurrence, for pregnant women who had undergone fistula repair, delivery by csection has been recommended. One patient had an early surgical repair because of intractable pain and the other patient because of the large size of the fistula. Intrauterine device induced vesicouterine fistula and urinary bladder stone. A 27yearold female patient, g2p2, was admitted to hospital with the complaint of severe crampy pelvic pain and dysuria during micturition without any incontinence. The disease presented with vaginal urinary leakage,cyclic hematuria and amenorrhea. Vesicouterine and vesicocervical fistulas are rare, accounting for approximately 4% of all urogenital fis tulas.
A vesicouterine fistula is a rare presentation in the context of an advanced health care system. The most common cause of this syndrome is trauma during a cesarean section. Vesicouterine fistulae resulted following cesarean. Grafts can include a womans own tissue or muscle that is placed over the repaired fistula tract. We present 3 cases of vesicouterine fistula with successful surgical repair in which 2 patients had an early repair. A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. They include bladder decompression with an indwelling catheter and medical management to induce. Vesicouterine fistulas vuf are the least common type of urogenital fistulas, which is defined as an uncommon communication between the bladder and the uterus or the cervix. The major risk factor is a previous cesarean section, which explains the growing. Previous research has described a woman of reproductive age who presented with a vesicouterine fistula vuf of 20 months duration.
Youssefs syndrome article pdf available in medical journal armed forces india 71suppl 1 january 2014 with 21 reads how we measure reads. Vesicouterine fistulae account for ito 4% genitourinaiy fistulae 1. View the article pdf and any associated supplements and figures for a period of 48 hours. Vesicouterine fistulas are usually associated with psychological distress and have a negative effect on quality of life. Our patient was managed by laparoscopic transperitoneal fistula disconnection and closure.
Abdominal repair of vesicovaginal and vesicouterine fistula. Vesicouterine fistula vuf represents a rare urogenital complication. The fistula repair surgeries were uneventful and the patients had an unremarkable recovery. The aim of this video is to present a case report and to provide a tutorial on the surgical technique of delayed transvaginal repair of a high vesicouterine fistula that developed after cesarean section with manual removal of a morbidly adherent placenta. A vesicouterine fistula is an abnormal communication between the bladder and the uterus. The most common cause is lower segment cesarean section. Lower urinary tract fistulas can communicate with the vagina or the uterus fig. This report concerns an extremely rare type of fistula, a vesicouterine fistula, in a 59yearold female occurring twenty years following brachytherapy for cervical cancer. The vuf was lined with a metaplastic glandular epithelium containing. Treatment of vesicouterine fistula by fulguration sciencedirect.
Repair of a vesicouterine fistula following cesarean section. Different therapeutical approaches that include conservative treatment, fulguration, hormonal therapy and open, laparoscopic or robotic surgeries have been mentioned in the. Frontiers consider the risk of vesicouterine fistula in the. To our knowledge, this is the fourth case report of a fetus in the bladder secondary to vesicouterine fistula. Vesicouterine fistula after a previous low vertical. Vesicouterine fistula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and. Vesicouterine fistula without vaginal leakage of urine, cyclic hematuria and amenorrhea is a rare condition, identified as youssefs syndrome. Excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. Pdf vesicovaginal fistula vvf is an abnormal communication between the bladder and the vagina. The management of genitourinary fistula in the third millennium. This condition is very rare and accounts for 1% to 4% of all urogenital fistulas, including vesicovaginal fistula, ureterovaginal fistula, and urethrovaginal fistula 1, 2. A cystogram 4 months after injury demonstrated a small fistulous tract from the posterior superior portion of the bladder to the uterine cavity. Pdf on jan 1, 2011, latika sahu published chapter21 vesicovaginal.
A vesicovaginal fistula vvf is an abnormal fistulous. Iatrogenic reasons have been shown to be the most prominent cause, with lower segment caesarean section accounting for approximately twothirds of the cases. This procedure was asso ciated with minimal blood loss and morbidity, and the patients hospital stay vvas less than 24 hours. Following uterovesical fistula repair, patients can maintain their fertilities, and healthy pregnancies after surgical fistula repair have been reported in the literature. There are multiple ways to investigate vuf and several examinations may be required to confirm the diagnosis. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep enough to reach another organ or the skin. Vesicouterine fistula resulting in a vesical pregnancy. It is considered to be the least common type of urogenital fistulas. May 17, 2012 a retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. In conclusion, helical ct appears as a valuable tool in depicting a vesicouterine fistula. Download as ppt, pdf, txt or read online from scribd. Complex vesicovaginal fistula repair with posterosuperior. Laparoscopic repair of vesicouterine fistulasingh et al urology journal vol 8 no 2 spring 2011 151 treatment of choice in such a case is vuf disconnection and closure of the bladder and uterine fistulous openings with interposition graft.
Discussion most cases of vesicouterine fistulas occur after low cesarean delivery 2, 3. Vesicovaginal fistula vvf is an abnormal fistulous tract. Vesicouterine fistula twenty years following brachytherapy. Vesicouterine fistula is a rare type of urogenital fistula. Nov 16, 2017 vesicouterine fistula is a rare complication of cesarean section. Current procedural terminology closure of vesicouterine. Patient morbidity in this case possibly could have been avoided with earlier diagnosis and access to care.
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