Obstetrical fistulae womens health and education center. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. A vaginal fistula is an abnormal opening that connects your vagina to another organ. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. The number of vesicovaginal fistulas in a region reflects the quality and the level. For example, a vaginal fistula can link your vagina to your bladder. Uterovesical fistula free download as powerpoint presentation. Discussion most cases of vesicouterine fistulas occur after low cesarean delivery 2, 3. Vesicouterine fistula is a rare type of urogenital fistula.
Current procedural terminology closure of vesicouterine. Objective to analyse the indications, diagnosis, major causes and basic principles of surgical treatment of vesico. The fistula was diagnosed from clinical, radiological and endoscopic findings. Vesicouterine fistula is an abnormal passageway between the cavities of the bladder and uterus. A duct or passage resulting from injury, disease, or a congenital disorder that connects an abscess, cavity, or. Vesicouterine fistula how is vesicouterine fistula. A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. The most common cause of vufs is cd, especially in women with multiple previous cds, because of dense adhesions between the bladder and uterus. This chapter also summarizes the most important current issues in the treatment of obstetric fistulas and suggests directions for muchneeded futu re research in. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. Vesicouterine fistula an analysis of 24 cases from. A case of vesicouterine fistula following caesarean section complication is presented. All six obstetrical cases were related to cesarean section. They discovered 14 such cases, and present the results of surgery, with advice on how to optimise the results.
Although vesicouterine fistula formation is a rare com plication of vaginal birth after cesarean, it should be presented during the consenting process as a potential risk and be considered in the differential diagnosis of postpartum urinary incontinence. 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. Fistulas in the developing world international continence society. Due to the large size of the fistula, early recognition and pain, immediate surgical repair was opted. In human female anatomy, the vesicouterine pouch, also known by various other names, is a second but shallower pouch formed from the peritoneum over the uterus and bladder, continued over the intestinal surface and fundus of the uterus onto its vesical surface, which it covers as far as the junction of the body and cervix uteri, and then to the bladder. Vesicouterine fistula is a rare type of genital fistula. In modern obstetric practice, more frequent use of cesarean delivery leads. The major risk factor is a previous cesarean section, which explains the growing number of reported cases in literature. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. 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. A fistula forms after significant scarring, fibrosis, and widespread destruction of the vagina.
Symeonidis,1 eliassdralis,2 asteriossymeonidis,1 christosgeorgiadis,1 vasileioskalyvas,1 apostolosmalioris,1 andmichailpapathanasiou1. A vesicouterine fistula may be defined as an abnormal communication between the bladder and uterine cavity above the level of the cervical internal os, which allows the menstrual blood to enter the bladder and causes cyclic hematuria. A rare complication of vaginal birth after cesarean to the editor. Early versus delayed repair of vesicouterine fistula. Vesicouterine fistula resulting in a vesical pregnancy. Vesicouterine fistulas are an uncommon and pathological communication between the bladder and the uterus or the cervix and represent 1% to 4% of all urogenital fistulas, with a peak incidence in young women between 25 and 33 years old. During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. Vesicouterine definition of vesicouterine by medical. 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. Youssefs syndrome classically presents as a triad of cyclical hematuria.
Although the treatment of women with obstetric fistulas is a worthy endeavour. Obstetric fistula geneva foundation for medical education and. Clinical manifestations vary and can be discrete and misleading. Vesicouterine fistula vuf as a rare urogenital complication managed with delayed surgical repair.
Laparoscopic repair of vesicouterine fistula singh 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. The vesicouterine fistula is visualized through hysteroscopy and cystoscopy. There was a 5cm long fistula between the uterus and the intertrigonal ridge. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep.
Youssefs syndrome is characterized by cyclic hematuria menouria, absence of vaginal bleeding amenorrhea, and urinary incontinence due to vesicouterine fistula vuf, the least common of the urogynecological fistulas. Reconstructive surgery with a trained, expert fistula surgeon can repair the injury, with success rates as high as 90 percent for less complex cases. Although the indications for abdominal repair of vesicovaginal fistula are somewhat controversial, certain conditions involving the. Vesicouterine fistulas account for only 1% to 4% of all urogenital fistulas. Pdf radiological diagnosis of vesicouterine fistula. Types of urogenital fistula vesicovaginal fistula vvfrectovaginal fistula rvfurethrovaginal fistula uvfureterovaginal fistula vesicouterine fistula etiology in developing countries marriage and conception at a young age, often before full pelvic growth has been achieved. A case report okafor ii1, amu co 2 and ogbodo sc1 1departments of obstetrics and gynecology, enugu state university of science and technology, teaching hospital, parklane, enugu, nigeria 2department of surgery, college of medicine, university of. Vesicovaginal fistulas are approximately three times more common than ureterovaginal fistulas, with ureterovesicovaginal fistulas being very infrequent.
Pdf vesicovaginal fistulas are among the most distressing complications of gynecologic and obstetric procedures. Vesicovaginal fistula, or vvf, is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. Radiation induced fistulas occur frequently many years after treatment. In addition to the medical sequela from these fistulas, they often have a profound effect on the patients emotional wellbeing. The symptoms are menouria and urinary incontinence excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula.
Vesicovaginal fistula vvf is an abnormal fistulous tract. A vesicouterine fistula is an abnormal communication between the anterior wall of the uterus and posterior wall of the urinary bladder. The diagnosis of vuf should be considered when there is a history of previous cesarean section. Spontaneous closure of vesicouterine fistula following. This study was undertaken to evaluate what clinical events or situations are currently associated with the occurrence of vesicouterine fistula. 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. Pdf diagnostic and management in vesicovaginal fistulas. Obstetric vesicovaginal fistula vvf is caused by direct pressure of the trapped fetus over a wide area of the pelvis for a prolonged period, resulting in tissue ischemia. Review of vesicouterine fistula at the national obstetric fistula centre, abakaliki, nigeria babafemi daniyan, ileogben sundayadeoye, kenneth ekwedigwe, danladi dantani and monday eliboh national obstetric fistula centre, abakaliki, nigeria abstract background.
A retrovesical approach for the laparoscopic repair of. Vesicouterine fistula is a rare complication of cesarean section due to a transverse incision into the lower segment. 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. Roboticassisted laparoscopic repair of a vesicouterine. Our patient was managed by laparoscopic transperitoneal fistula disconnection and closure.
Vesicouterine fistula vuf is a very rare type of urogenital fistula, the incidence of which has increased in recent years due to increased cesarean section deliveries and other. Spontaneous antepartum vesicouterine fistula causing. Miklos et all recently described the occurrence of a vesicovaginal fistula during a trial of labor after cesar ean. This procedure was asso ciated with minimal blood loss and morbidity, and the patients hospital stay vvas less than 24 hours.
Only 5% of patients respond to conserva tive management, whereas other patients require definitive surgical repair 1. After instilling indigo carmine into the uterine cavity, extravasation of dye through the fistula into the bladder is seen. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of. Abdominal repair of vesicovaginal and vesicouterine fistula. The treatment and prevention of vesicouterine fistula is discussed with particular reference to our setting. Vesicouterine fistula is a rare complication of gynecologic surgery, which is usually treated by abdominal hysterectomy and bladder repair. Lower urinary tract fistulas can communicate with the vagina or the uterus fig. Obstetric fistula can be prevented and in most cases treated.
Frontiers consider the risk of vesicouterine fistula in. Vesicouterine fistula presenting with urinary incontinence 30 years after primary cesarean. 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. The incidence is on the rise because of increasing incidence of cesarean sections. Most of these fistulas are due to complications of the lower segment cesarean section lscs. Roboticassisted laparoscopic repair of a vesicouterine fistula, changjackson sr et al. Youssefs syndrome has a variable clinical presentation. Vesicouterine fistula is an uncommon urogenital fistula.
Vesicouterine fistulae vuf comprise 29% of all cases of urogenital fistulae. The main complication of vvf surgery is recurrent fistula formation. Among different types of genitourinary fistula, vesicouterine fistula vuf is the rarest form, accounting for 14% of all genitourinary fistulas. They may be associated with endom etriosis 4 as in our fig.
452 1149 617 1501 1580 203 379 795 771 541 458 837 1001 1459 311 718 624 1630 819 1399 969 787 1352 73 698 1240 1006 247 468 1528 482 628 531 1315 339 543 129 111 967 104 926 997