In some cases of small fistula, no obvious tract may be noted. These are conservative, medical or surgical treat ments. This video nicely depicts the laparoscopic repair of a vesicouterine fistula. Hysterography may show leakage of contrast media into the bladder.
The objective of our report is to present three cases of vesicouterine fistulas. Characteristics and repair outcome of patients with vesicovaginal fistula managed in jimma university teaching hospital, ethiopia. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep enough to reach another organ or the skin. In addition to the medical sequela from these fistulas, they often have a profound effect on the patients emotional wellbeing. Anorectal fistula the digestive system an anorectal fistula is an abnormal channel that leads from the anus or rectum usually to the skin near the anus but occasionally to another organ, such as the vagina. Vesicouterine fistula article about vesicouterine fistula. Longterm outcome of laparoscopic vesicouterine fistula. Cystoscopy can reveal the presence of fistula, however if the fistula tract can not be dilated then it can not determine the extend of the fistula tract. The tunnel formation allows contaminants and waste products to leak where they are. Laparoscopic repair of vesicouterine fistulasingh et al urology journal vol 8 no 2 spring 2011 151 treatment of choice in such a case is vuf disconnection and closure of the bladder and uterine fistulous openings with interposition graft. Vesicouterine fistulae are becoming more common because of the increase in the. If you have a fistula, urine will leak from the vagina, and since the vagina is not designed to hold urine you will not be able to control this. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. Vesicouterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during caesarean section 83%93% of cases especially emergency caesarean section.
One patient had an early surgical repair because of intractable pain and the other patient because of the large size of the fistula. Conservative management of uterovesical fistula following. A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. Although the obstetric fistula was once common in western europe and the united states, it is virtually unknown in these regions today. The type of urogenital fistula is based upon the anatomic location of the connecting tract.
Cyclical hematuria or menouria is an important clinical feature of this fistula which may or may not be associated with urinary incontinence depending on the location of the fistulous tract. Fistula development ii if mother survives, a macerated fetus is expelled 34 days later sloughing of devitalized tissue bladder, vagina 10 days later wide area of pressure results in an anatomical area widely affected by scarring and devascularization types of obstetrical fistulas elkins vesicouterinecervicalcs and inlet. However the incidence of vesicouterine fistula has been on the rise due to increasing incidence of lower segment caesarean section lscs. Vesicouterine fistula is an uncommon urogenital fistula. Vesicouterine fistula is a rare complication of gynecologic surgery, which is usually treated by abdominal hysterectomy and bladder repair. The work presents a rare case of spontaneous migration of an 11week fetus from the uterine cavity into the urinary bladder cavity through the longstanding vesicouterine fistula. Vesicovaginal fistulas can be congenital present at birth or acquired developing over time. Conservative management of uterovesical fistula following primary caesarean section.
Pdf characteristics and repair outcome of patients with. Bladder wall is disrupted, with hypoechoic line arrow joining bladder and uterus. Vesicouterine fistula is a rare complication of caesarean delivery. This tunnel is an anomaly, doctors do not know why the tunnel forms but they do know the results of this tunnel formation. The symptoms are menouria and urinary incontinence excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. Obstetrical fistulae womens health and education center. Laparoscopic treatment of vesicouterine fistula miklos bladder drainage for 4 weeks with a transurethral foley catheter. It can occur as a standalone fistula or can accompany a. A duct or passage resulting from injury, disease, or a congenital disorder that connects an abscess, cavity, or. Treatment of vesicouterine fistula by fulguration sciencedirect. It is seen more after repeat caesarean section rather than after the primary 1, 2. Implementation guide purpose of the manual to enable dedicated physicians to acquire the knowledge, skills and professionalism needed to. Vesicouterine fistula is a rare iatrogenic urogenital fistula that communicates between urinary bladder and uterus or rarely cervix.
Vesicouterine fistula, a rare cause of genitourinary fistula ncbi. The vesicouterine fistulae vuf comprise 29% of all urogenital fistulae. They discovered 14 such cases, and present the results of surgery. Youssefs syndrome is characterized by cyclic hematuria menouria, absence of vaginal bleeding amenorrhea, and urinary incontinence due to vesicouterine fistula vuf, the least common of the urogynecological fistulas. Lower urinary tract fistulas can communicate with the vagina or the uterus fig. Obstetric fistula geneva foundation for medical education and. Excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. This is the third known report of vesicouterine fistula diagnosed during pregnancy.
They include bladder decompression with an indwelling catheter and medical management to induce. Cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more. Vesicouterine definition of vesicouterine by medical. Emergency lower segment cesarean section is the most common cause of vuf which accounts for 23 rd of the cases. Urethrovaginal fistula is a distinct type of fistula that has to be differentiated from vesico vaginal fistula. Vesicouterine fistula is an abnormal passageway between the cavities of the bladder and uterus. Vesicouterine fistulae are uncommon and have been estimated to account for only 1% to 4% of all genitourinary fistulae.
Vesicovaginal fistula vvf is a subtype of female urogenital fistula ugf. Anorectal fistulas are common among people who have an anorectal abscess, crohn disease, or tuberculosis. The prevalence of obstetric fistulas has also fallen precipitously in the. Vesicovaginal fistulas are approximately three times more common than ureterovaginal fistulas, with ureterovesicovaginal fistulas being very infrequent.
Eight cases of vesicouterine fistula vuf obstetrical etiology in six cases and inflammatory bowel disease in two have been treated in the past 14 years. If uterovesical fistula was made immediately after. Pdf radiological diagnosis of vesicouterine fistula. Vesicovaginal fistula vvf affects an estimated three million women internationally. The incidence is on the rise because of increasing incidence of cesarean sections. Treatment options of vesicouterine fistulas are vari ous. A vesicovaginal fistula is an abnormal connection between the bladder which stores urine and the vagina. Conservative management of uterovesical fistula following primary caesarean section bastakoti r1, saha r2. Vesicouterine fistula presenting with urinary incontinence 30 years after primary cesarean. Ct scan with intravenous contrast media or ct with sagittal reformation after hysterography is also. Vvf is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
The fistula repair surgeries were uneventful and the patients had an unremarkable recovery. To retrospectively assess the value of magnetic resonance imaging mri in the diagnosis of vesicouterine fistula vuf. Because the tract did not close spon taneously, the patient was offered surgery. We are reporting on a case in which the chronic fistula was caused by an iud having been placed 4. We present 3 cases of vesicouterine fistula with successful surgical repair in which 2 patients had an early repair. Current procedural terminology closure of vesicouterine. Surgical repair is the gold standard treatment for vvf and numerous closure.
The national center for biomedical ontology was founded as one of the national centers for biomedical computing, supported by the nhgri, the nhlbi, and the nih common fund under grant u54hg004028. Sexual assault has been linked to obstetric fistula, especially in conflict settings. Vesicouterine fistula vuf is a rare type of fistula accounting for only 14% of all cases of urrogenital fistula. May 17, 2012 a retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. Using excretory urography it is difficult to distinguish vesicovaginal fistula from vesicouterine fistula, because presence of contrast media in vagina is the only finding. A fissure creates severe pain and is like a crack in the skin.
Scribd is the worlds largest social reading and publishing site. Vesicouterine definition of vesicouterine by medical dictionary. Doctor answers on symptoms, diagnosis, treatment, and more. Surgery is the treatment of choice in most cases, especially for large vesicouterine fistulas which invariably necessitate surgical closure. The symptoms are menouria and urinary incontinence. Vesicouterine fistula, a rare cause of genitourinary fistula. Abdominal repair of vesicovaginal and vesicouterine fistula. The authors report 5 cases of uterovesical fistula uvf and analyse some of the clinical and therapeutic aspects of this disease.
A vesicovaginal fistula connects a womans bladder directly to her vagina, which causes urine to drain into the vagina without passing through the urethra and results in loss of bladder control. Vesicouterine fistula is a rare complication of cesarean section due to a transverse incision into the lower segment. The variety of problems encountered is enormous, which. For a vesicouterine fistula it seemed that the thick uterine wall with a good blood supply would be even more suitable for this form of treatment. Laparoscopic repair for vesicouterine fistulae introduction. Fistula development ii if mother survives, a macerated fetus is expelled 34 days later sloughing of devitalized tissue bladder, vagina 10 days later wide area of pressure results in an anatomical area widely affected by scarring and devascularization types of obstetrical fistulas elkins vesicouterine cervicalcs and inlet. A fistula going from the rectum to the scrotum would be life threatening. Complications of fistula repair surgery sherif mourad in the developing world, the true incidence of obstetric fistulas is unknown, as many patients with this condition suffer in silence and isolation.
The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus. They may be associated with endom etriosis 4 as in our fig. Our patient was managed by laparoscopic transperitoneal fistula disconnection and closure. A free and open source software to merge, split, rotate and extract pages from pdf files. Followup cystogram after fulguration of fistula well in our hands. Vesicouterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during caesarean section. Youssefs syndrome has a variable clinical presentation. In a retrospective study of 604 consecutive patients seeking treatment for fistula in the democratic republic of congo, 24 4% had fistula related to sexual assault. Although there are reports in the literature about pregnancy in the presence of vesicouterine fistula, cases of movement of the fetus through the fistulous tract are extremely rare 1012. One patient who reported 3 months after the cesarean section was managed by estrogen and progesterone.
Combining it with reverse trendelenburg positioning enhances visualization with this technique. Congenital vesicovaginal fistula wiley online library. The location of the fistula in relation to the vaginal apex and bladder trigone should be inspected and the quality of the surrounding tissue inflammation, edema, or infection noted. The obstetric vesicovaginal fistula in the developing world. Obstetrical fistulas johns hopkins bloomberg school of.
Discussion most cases of vesicouterine fistulas occur after low cesarean delivery 2, 3. Marinsanchez p1, sanchezferrer ml2, garridonavarro c1. Linda pseudonym, a 28yearold woman in her second pregnancy, having had a caesarean delivery in her first pregnancy, was admitted to the delivery unit with possible preterm ruptured membranes at 23 weeks gestation. In our case, during cystoscopy, a large fistula opening was seen, then cystoscope was advanced up to the uterine horns, and after visualization of the whole tract, diagnosis was made. All six obstetrical cases were related to cesarean section. Vesicouterine fistulae resulted following cesarean. Vesicouterine fistula definition of vesicouterine fistula. During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. Between january 2003 and january 2011, 12 patients with a diagnosis of vuf. There is a welldefined defect in the lower anterior uterine body and posterior urinary bladder wall in the area of the prior cesarean section. There are some reports of success with the conservative treatment. We are reporting on a case in which the chronic fistula was caused by an iud having been placed 4 years ago. In the treatment of uterovesical fistulas, conservative or surgical techniques have been used.
Understanding vesicocolic fistula symptoms starts with understanding exactly what a fistula is. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100%. We present a survey of spontaneous migration of an 11week fetus from the uterine cavity into the urinary bladder through the longterm vesicouterine fistula. Linda pseudonym, a 28yearold woman in her second pregnancy, having had a caesarean delivery in her first pregnancy, was admitted to the delivery unit with possible preterm ruptured membranes at 23. Vesicouterine fistula how is vesicouterine fistula.
Complications of fistula repair surgery sherif mourad. Although the indications for abdominal repair of vesicovaginal fistula are somewhat controversial, certain conditions involving the. Cpt code information is available to subscribers and includes the cpt code number, short description. Early versus delayed repair of vesicouterine fistula ncbi. In particular, the epidemiology, aetiology, diagnosis, treatment and prevention of non obstetric fistula have been described in detail during the recent international. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. After a thorough discussion of surgical approaches and informed consent, she elected to proceed with lapa roscopic repair.
First steps in vesicovaginal fistula repair i know of no other condition where such a variety exists from the simplest case, which can be completed in half an hour, to the most dif. Early versus delayed repair of vesicouterine fistula. This is compatible with an acquired vesicouterine fistula. Vesicovaginal fistula, or vvf, is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. All patients in the present study had history of lower segment cesarean section. Uterovesical fistula free download as powerpoint presentation. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. Mar 01, 2016 vesicovaginal fistula vvf is a subtype of female urogenital fistula ugf.754 1476 529 166 939 1249 1027 1638 73 390 166 772 436 1386 871 648 1471 1303 1222 286 1361 530 102 477 1034 537 666 887 382 1571 1588 60 161 245 1485 784 121 619 80 825 77 1281 1344 154 527 177 1156 1198 740