Post Caesarean Vesicouterine Fistulae – Youssef Syndrome: Our Experience and Review of Published Work

Abstract

Vesicouterine fistulae, despite being infrequent, are no longer a rare diagnosis and are most commonly secondary to lower segment caesarean section. With patient history and selected investigations diagnosis is relatively easy. The surgical repair of these fistulae is standard treatment, especially with delayed fistulae with achievement of total continence, and complete resolution of cyclic haematuria. Meticulous practice of obstetric and surgical principles during caesarean section can prevent the formation of these fistulae.

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

“…1 It is a rare complication due to accidental opening of the bladder during cesarean delivery. 1,2 In the VUF that occurs in 1-4% of all urogenital fistulas, most patients do not experience any urinary incontinence. [2][3][4] Although VUF can be seen after primary cesarean delivery, it is most commonly seen after multiple cesarean sections and incidence tends to increase with incremental use of low-segment cesarean section.…”

Management of Vesicouterine Fistula with Abdominal Approach

“…11 Obstetrik girişimlerden önce mesanenin boşaltılması, cerrahi prensiplere dikkat edilmesi ve alt uterin segmentin dikkatli diseksiyonu fistül oluşma riskini en aza indirmektedir. 12,13 Rajamaheswari ve ark. 17 vakayı içeren çalış-malarında, VUF'lerin %76,5 (13/17)'inin tekrarlayan C/S operasyonları sonucu geliştiğini belirtmişlerdir.…”

“…Ancak, postoperatif "de novo urgency" şikâyetleri olan 2 (%50) hastaya postoperatif dönemde antimuskarinik ilaç başlandı. Ortalama 14,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] aylık izlemlerde hiçbir hastada nüks saptanmadı.…”

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

“…Emergency lower segment cesarean section is the most common cause of VUF which accounts for 2/3 rd of the cases. [4] All patients in the present study had history of lower segment cesarean section. Excessive intraoperative bleeding, abnormal position of placenta (placenta previa/percreta), incomplete reflection of bladder wall from uterus, uterine rupture, attempted forceps delivery and previous cesarean section are significant risk factors for VUF.…”