Early versus delayed repair of vesicouterine fistula

Abstract

Vesicouterine fistulas (VUF) are a pathological and uncommon connection between the uterus and the bladder. Although rare, they are usually related to cesarean section. Nowadays, their incidence increases because of the increase in Cesarean sections. Patients with VUF may have various clinical presentations. The main symptoms are urinary incontinence, which may be associated with hematuria. Vesicouterine fistulas are usually associated with psychological distress and have a negative effect on quality of life. The accurate and early diagnosis of VUF can be difficult. There are multiple ways to investigate VUF and several examinations may be required to confirm the diagnosis; these examinations may include a cystoscopy, a retrograde cystography, methylene blue test and a computed tomography scan. We present 3 cases of vesicouterine fistula with successful surgical repair in which 2 patients had an early repair. One patient had an early surgical repair because of intractable pain and the other patient because of the large size of the fistula. The fistula repair surgeries were uneventful and the patients had an unremarkable recovery. We report that early surgical management is technically feasible without significantly increasing the difficulty of the surgery, with an excellent outcome in selected patients.

Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef’s syndrome)

“…8 VUF was previously seen after vaginal delivery performed with forceps, but now 83-93 % of cases are seen after cesarean section. 9 Some risk factors for VUF include: insufficient dissection of the bladder from the lower segment of the uterus, excessive intraoperative bleeding, use of vacuum and forceps, manual removal of the placenta, placenta percreta, uterus rupture, previous cesarean section, and abortion history.…”

“…Surgical approach is performed for all wide fistulas and small fistulas that do not have spontaneous recovery after a three-month conservative followup. 20,21 For a surgical approach, options include transabdominal, endoscopic, and robotic procedures; hysterectomy is also an option if there is no desire for fertility. 22 If there is desire for fertility, fistula repair is essential and success rate is high; pregnancy after repair has been reported.…”

Vesicouterine fistula, a rare cause of genitourinary fistula

“…[2] Son yıllarda artan sezaryen oranları, genitoüriner fistüller gibi ameliyata bağlı komplikasyonların görülme sıklığının da artışını beraberinde getirmiştir. [3] Uterovezikal fistüllerin klinik prezentasyonu çeşitlilik göstermektedir.…”

“…[12,13] Uterovezikal fistül tanısının hemen doğumdan sonra konulması durumunda konservatif tedavi yöntemi uygulanabileceği ve seçilmiş vakalarda erken cerrahinin de başarılı sonuçları literatürde bildirilmiştir. [2] Cerrahi sonrası dönemde kontrol edilemeyen ağrıları olan hastalar ile geniş boyutlu fistülü olan hastalarda erken dönemde cerrahi tedavi düşünülebilir. [2] Uterovezikal fistül onarımı sonrasında hastaların fertiliteleri devam edebilmektedir ve literatürde cerrahi sonrası sağlıklı gebelik bildirilmiştir.…”

Vesicouterina fistula: Youssef's syndrome

“…Transabdominal yaklaşımların başarı oranı %94-100 arasındadır (15,9). Veziko-uterin fistüllerin tedavisinde histerektomi genel olarak önerilmemektedir (16). Fakat hastanın eşlik eden genital patolojisi, yaşı, fertilite isteği göz önünde bulundurularak planlanan histerektomininde uygulanabileceğini bildiren otörlerde vardır (13).…”