Showing papers on "Uterine Fistula published in 2018"

Video of the laparoscopic repair of a vesico-uterine fistula.

Abstract: Vesico-uterine fistulas (VUFs) are rare in modern gynecological practice. We aim to demonstrate with a video the surgical techniques involved in laparoscopic repair of a vesico-uterine fistula (Youssef’s syndrome). A 37-year-old woman, para 2 and otherwise healthy, was referred to the Urogynaecology Unit 4 months following a vaginal birth after a previous cesarean, with ongoing pink-colored vaginal watery discharge. Cystoscopy and hysteroscopy confirmed the findings of a well-granulated fistulous tract connecting the base of the bladder and anterior uterine wall just above the level of the internal os. She underwent an uncomplicated laparoscopic repair of VUF. She has remained asymptomatic with resumption of normal menses and no clinical evidence of fistula recurrence at 6-week and 6-month post-operative reviews. This video demonstrates the surgical techniques involved in the laparoscopic repair of a VUF, a rare case in modern gynecological practice where there are few surgical videos demonstrating techniques.

Vesico-Uterine Fistula after TURB in pregnancy, a rare cause of genitourinary fistula.

Abstract: Vesico-uterine fistulas (VUFs) are rare genitourinary fistulas developing, in most cases, secondary to iatrogenic aetiologies such as repeated Caesarean sections (CSs) [1]. In this article, we report the first published case of a VUF after transurethral resection of the bladder (TURB) during pregnancy. A 38-year-old multiparous woman in her seventh pregnancy, having had three previous CSs, presented at the 20th week of gestation with macroscopic haematuria. She had a history of a uterine perforation, which had occurred about 15 years previously caused by an intrauterine device (IUD). The IUD had migrated to the bladder and was removed by laparotomy. After this surgery she had two subsequent pregnancies with delivery at term. At admission the vaginal ultrasound examination showed a normal intrauterine pregnancy and a polypoid tumour in the posterior wall of the urinary bladder. A cystoscopy confirmed the ultrasonography finding. A broad based solid non-specific tumour with calcification was found in the posterior wall of the bladder. The cytology was benign. Two cold biopsies were taken during the cystoscopy and these showed necrosis and calcification. Additionally a TURB was performed in order to exclude malignancy. The patient was admitted to the obstetric department two days later with suspected preterm rupture of the membranes at the 22nd week of gestation. The vaginal ultrasound as well as a new cystoscopy demonstrated the ballooning of the foetal membranes into the urinary bladder through an eight-millimetre defect in the bladder wall (Figure 1). The creatinine level in the watery discharge from the vagina corresponded to that of urine. The histopathology report from the TURB showed urothelial tissue with decidua components and necrosis. A decision was made to treat the patient and the pregnancy conservatively and not to interfere surgically at that time in order to prolong the pregnancy as long as possible. Antibiotic prophylaxis was given with Nitrofurantoin, initially 50mg once daily, increased to 50mg three times daily due to a culture positive for enterococcus faecalis. Serum C-reactive protein was <5mg/L. After one week in-hospital observation at the county hospital she was discharged and followed in the outpatient clinic. At 25 weeks of gestation she was referred to the University Hospital due to a shortening of the cervix to 14mm, preterm premature rupture of membranes and signs of foetal distress. An emergency CS was conducted and a premature girl was delivered. The fistula closure was performed at the same time. The uterus was separated from the bladder and a cystostomy was performed. The bladder and the uterus were sutured with absorbable sutures in one layer and the omentum major was interposed between them (Figure 2). After three weeks, the cystography showed no evidence of leakage and the transurethral catheter was removed. At the clinical control six months after the surgery the patient presented with some problems with dysuria and pain but no signs of urinary incontinence. During the six-month period, urinary tract infection had occurred twice. The mother and the baby were in a good general condition.