Review of Vesicouterine Fistula at the National Obstetric Fistula Centre,\ Abakaliki, Nigeria

Abstract

Background: Vesicouterine fistula is a rare type of genital fistula. It is a cause of urinary incontinence in our environment. It usually results from caesarean section. The study was undertaken to document our experience in the management of this condition.Methodology: This is a retrospective study carried out at the National Obstetric Fistula Centre, Abakaliki, Nigeria from January 2013 to October 2015. Records of women with vesicouterine fistula were retrieved. Information on age, parity, predisposing factors, aetiology, presentation, diagnosis, management and outcomes of repair were obtained. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20.Results: Vesicouterine fistula was seen in 13 out of 619 women constituting 2.1% of all genital fistulas. The mean age of the women was 37.4 ± 9.9 years with 53.5% of them between 30-39 years. Of the 12 women who had term pregnancies, 3 (25%) had no previous caesarean section, 4 (33.3%) had 1 previous caesarean section and 5 (41.7%) had 2 previous caesarean sections making previous caesarean section a predisposing factor in 75% of cases. Fistula occurred following caesarean section in 7 women (53.8%), vaginal delivery in 4 (30.8%), exploratory laparotomy due to uterine rupture in 1 (7.7%) and dilatation and curettage in 1 (7.7%). All 4 women whose fistula followed vaginal delivery had previous caesarean section. All the 13 women presented with menouria. Two (15.4%) had menouria only while11 (84.6%) had menouria with urinary incontinence. In 6 women (46.2%), diagnosis was clinical. Hysterosalpingogram was employed in 1 patient. All the women had surgical repair via the retropubic extraperitoneal approach. Fistula was closed in all 13 women. Conclusion:Vesicouterine fistula is uncommon and usually follows caesarean section. Previous caesarean section is an important predisposing factor. It presents commonly as menouria and urinary incontinence. Outcomes of repair are excellent.

Diagnosis and Management of Vesicouterine Fistula (Youssef’s Syndrome): A Case Report

“…Vesicouterine fistula (VUF) is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder. 1 Cesarean section is the single most common cause of VUF, approximately 83-93% of all cases. Although vesicouterine fistula represents only 1-4% of all urogenital fistulas its prevalence is increasing all over the world due to the increased rate of caesarean section.…”

“…Vesicouterine fistula (VUF) is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during Caesarean section with a prevalence of approximately 1-4% of all urogenital fistulas. 1 The prevalence is increasing due to the increased rate of caesarean delivery. Youssef's syndrome is an atypical presentation of a patient with VUF, characterized by a triad of cyclical hematuria, amenorrhea, and absence of urinary incontinence.…”

Comparison of patterns of obstetric fistula between two periods in South-East Nigeria

“…15 Caesarean section is also the most important factor in the causation of vesico-uterine fistula in our environment. 16 Ironically, Caesarean section which is supposed to prevent the occurrence of obstetric fistula is emerging as a leading cause in our environment. [14][15][16] Consequently, it became imperative to study the patterns of this devastating public health problem at different periods in time to determine if there are changes so that policy makers can develop new preventive and treatment approaches to tackle the scourge.…”

“…16 Ironically, Caesarean section which is supposed to prevent the occurrence of obstetric fistula is emerging as a leading cause in our environment. [14][15][16] Consequently, it became imperative to study the patterns of this devastating public health problem at different periods in time to determine if there are changes so that policy makers can develop new preventive and treatment approaches to tackle the scourge. The study was therefore carried out to compare the demographic characteristics, aetiology, presentation, management of obstetric fistula patients seen within two different periods at the National Obstetric Fistula Centre, Abakaliki.…”

Obstetric Fistula – An Unceasing Scourge in the Developing World

“…These include extreme poverty, malnutrition, illiteracy, early marriage, lack of antenatal care, lack of access to facilities with skilled birth attendants, poor funding of health systems, and cultural practices such as female genital mutilation, aversion to operative delivery and nonparticipation of women in decision making [9][10][11][12]. Less commonly, obstetric fistula may also result from surgical procedures such as caesarean section [13,14].…”