Vesicouterine fistula: An updated review

Abstract

To ascertain the condition of vesicouterine fistula, a search of the medical literature using the Ovid version (Ovid Technologies Inc., New York, USA) of Medline (1966-1997) was undertaken, using the keywords vesicouterine, vesico-uterine, uterovesico, and utero-vesico fistula. A search of the earlier medical literature was by cross-referencing and is likely to be less complete than the computerized database. Nonetheless, the authors believe the most relevant publications were cited. On reviewing the subject it was noticed that there had been a change in obstetric practice between the first and the latter half of this century, namely an increase in the incidence of cesarean deliveries. However, the literature contains relatively little information on pathophysiology, possibly owing to the relative rarity of the lesion. Emphasis has been given to the most recent 10 years (1987-1997) in order to update the etiology, diagnosis and management of this clinical condition.

Vesicouterine fistula presenting with urinary incontinence 30 years after primary Cesarean: Case report and review of the literature

“…6 The possible mechanisms underlying the development of vesicouterine fistula include inadequate mobilization of the bladder flap, sutures passing through the bladder wall, unrecognized trauma to the bladder wall, excessive devascularization of the bladder during dissection, and cauterization. 7,8 The risk increases in repeat Cesarean sections because of scarring and the presence of dense adhesions obscuring dissection in the right planes.…”

“…15 Oral contraceptives, progestational agents, and gonadotropin releasing hormone analogs have been used to induce amenorrhea. 6 Surgery is the definitive method of treatment. It can be performed transabdominally, endoscopically, and robotically.…”

The Use of an Anterior Abdominal Wall Peritoneal Flap in the Laparoscopic Repair of Vesicouterine Fistula

“…In the literature, omentum is the major flap that is used for tacking, because it is mobile and has a good blood supply. 2 Myouterine flaps 13 or appendices epiploica flaps would be the second choice after omentum, where it was sometimes of insufficient length to be used or formerly excised. We think that preparation of an anterior abdominal wall flap would be easier than myouterine flaps when using minimally invasive techniques such as laparoscopy or robotic surgery.…”

“…The management of VUF becomes more important when the prevalence for an 11-year time interval approximately equals the prevalence for the prior 38 years. 2 Inadequate bladder mobilization, accidental suturing of the bladder wall, and direct trauma are the possible mechanisms causing VUF. These patients mostly present with the classic triad of menouria, amenorrhea, and urinary incontinence, with a history of previous cesarean section.…”

Conservative management of vesicouterine fistula after uterine rupture

“…According to Yip and Leung, 83% of vesicouterine fistulas reported between 1986 and 1997 were caused by primary or repeat cesarean section [2], Surgery is the mainstay of management for this complication. We report a case where conservative management alone was successful in closure of the fistula.…”