Vesico‐uterine Fistula
TL;DR: Nine cases of vesico-uterine fistula caused by injury to the bladder at Caesarean section or by rupture of the uterus and bladder following obstructed labour are described.
Abstract: Summary— Nine cases of vesico-uterine fistula caused by injury to the bladder at Caesarean section or by rupture of the uterus and bladder following obstructed labour are described.
Symptoms depend on the level of the lesion, menstruation into the bladder and menouria occurring when the fistula is above the internal cervical os: whatever the level, most patients with vesico-uterine fistula present with incontinence of urine.
A transperitoneal approach appears to give better results than a transvesical repair.
Citations
More filters
TL;DR: In this paper, a case-control study of women undergoing cesarean delivery at Women and Infants Hospital between January 1995 and December 2002 was conducted to identify risk factors for bladder injury.
174 citations
TL;DR: Overall, successful repair of urinary tract fistulas can be achieved in the majority of cases and a variety of approaches and techniques are used.
114 citations
TL;DR: This paper proposes intraoperativesonography by the transvaginal (or transrectal) route for the Foleytransurethral catheter producing bloody urine, for suspecting bladder injury while dissecting the uterine lower segment and for monitoring patients who already had had vesicouterine fistula repair.
Abstract: Herein we report on 1 more case of vesicouterine fistula followingcesarean section with review and update of the literature concerningthis unusual topic. The disease presented with vaginal urinary leakage,cyclic hematuria and amenorrhea. The fistula was successfully repairedby delayed surgery. Actually, all over the world the prevalence of thedisease is increasing for the frequent use of the cesarean section.Fistulas may develop immediately after a cesarean section, manifest inthe late puerperium or occur after repeated procedures. Spontaneoushealing is reported in 5% of cases. Vesicouterine fistulaspresent with vaginal urinary leakage, cyclic hematuira (menouria),amenorrhea, infertility, and first trimester abortions. The diagnosis isruled out by showing the fistulous track between bladder and uterus aswell as by excluding other more frequent urogenital fistulas. Thedisease treatment options include conservative treatment as well assurgical repair. Rarely, patients refuse any kind of treatment becauseof the benignity of symptoms and prognosis of the disease. Conservativemanagement by bladder catheterization for at least 4–8 weeks isindicated when the fistula is discovered just after delivery since thereis good chance for spontaneous closure of the fistulous track. Hormonalmanagement should be tried in women presenting with Youssef's syndrome.Surgery is the maninstay and definitive treatment of vesicouterinefistulas after cesarean section. Patients scheduled for surgery shouldundergo pretreatment of urinary tract infections. Surgical repair ofvesico-uterine fistulas are performed by different approaches whichinclude the vaginal, transvesical-retroperitoneal and transperitonealaccess which is considered the most effective with the lowest relapserate. Recently, laparoscopy has been proposed as a valid option forrepairing vesicouterine fistulas. The endoscopic treatment may beeffective in treating small vesicouterine fistulas. The pregnancy rateafter repair is 31.25% with a rate of term deliveries of25%. The disease may be prevented by emptying the bladder as wellas by carefully dissecting the lower uterine segment. It is advisablethat after vesicouterine fistula repair delivery should be performed byrepeating a cesarean section since the risk of fistula recurrence.Usually, vesicouterine fistulas are diagnosed postoperatively. As aresult, at least 95% of patients will undergo another operationfor repairing the fistula. In the meantime they are bothered by relatedsymptoms which impair their quality of life. As far as we are concernedintraoperative diagnosis is the gold standard in detecting vesicouterinefistulas for allowing immediate repair. We propose intraoperativesonography by the transvaginal (or transrectal) route for the Foleytransurethral catheter producing bloody urine, for suspecting bladderinjury while dissecting the uterine lower segment and for monitoringpatients who already had had vesicouterine fistula repair. As a resultpatients will avoid the familial and social problems related to thedisease as well another operation. Moreover, ultrasound Dopplerexamination may help in better investigating and understanding thepathophysiology of vesicouterine fistulas.
98 citations
Cites background from "Vesico‐uterine Fistula"
...Conservative management by bladder catheterization for at least 4– 8 weeks is indicated when the fistula is discovered just after delivery since there is good chance for spontaneous closure of the fistulous track [1, 3, 4 , 11, 12, 26, 33, 39, 42]....
[...]
...Surgery is still the mainstay and definitive treatment of vesicouterine fistulas after cesarean section [ 4 ]....
[...]
...Injuries to the bladder discovered while performing cesarean section or laparotomy for ruptured uterus should be immediately repaired [ 4 , 39]....
[...]
...The extraperitoneal transvesical approach has the advantage to get the peritoneal cavity free from contamination as well as to lead easily and directly to the mouth of the fistula in the bladder [ 4 , 25, 31, 40] Usually the extraperiotoneal route is approached through a subumbelical paramedian incision....
[...]
...Generally, surgical repair of the fistula is performed 3–4 months after cesarean section because uterine involution has taken place at that time and the reaction to initial surgery should be minimal [1, 4 ]. There is tendency to perform early surgery in repairing vesicouterine fistulas in order to avoid social and familial limitations of the disease....
[...]
TL;DR: 4 cases of a vesicouterine fistula after cesarean section are reported, three patients had normal pregnancies after resolution of the problem and three patients were treated surgically.
71 citations
TL;DR: 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 and the literature contains relatively little information on pathophysiology, possibly owing to the relative rarity of the lesion.
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.
49 citations
References
More filters
TL;DR: Thorough investigation of my case has revealed that all the interesting features of this syndrome can be explained by the presence of a functional sphincter at the uterine isthmus.
203 citations
TL;DR: Vesicocervical fistulas which occur after cesarean section may fit a clinical pattern of apparent amenorrhea, cyclic hematuria, and absence of urinary leakage via the vagina.
35 citations
TL;DR: An unusual case of spontaneous healing of a vesicouterine fistula after cesarean section is reported.
29 citations
TL;DR: Most of the fistulae were approached per vaginam, but in 37 cases the fistula was fixed high in the pelvis and abdominal repair was therefore preferred, usually by the intravesical route.
Abstract: SUMMARY
One hundred and two of 422 vesical fistulae personally treated since 1953 were either high in the vaginal vault or in the cervix. The majority were due to pressure necrosis during obstructed labour: 24 followed lower segment Caesarean section, 16 followed hysterectomy and 2 resulted from the combined effects of surgery and radiotherapy.
The repair techniques used by the author are summarised. Most of the fistulae were approached per vaginam, but in 37 cases the fistula was fixed high in the pelvis and abdominal repair was therefore preferred, usually by the intravesical route. Four uretero-vaginal fistulae had to be dealt with subsequently.
Eighty-six fistulae were successfully closed at the first attempt and the remaining 16 patients were all cured later except 2, who were lost to follow-up.
21 citations
13 citations