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Paluku JL, Furaha CM, Bartels SA, Aksanti BK, Kataliko BK, Kasereka JM, Kamabu EM, Kalole BK, Muteke JK, Kyembwa MM, Kabuyanga RK, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. Obstetric vesico-uterine fistula in nine reference hospitals in the Democratic Republic of the Congo: epidemiological, clinical, and therapeutic aspects. BMC Womens Health 2024; 24:309. [PMID: 38783309 PMCID: PMC11112946 DOI: 10.1186/s12905-024-03124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION With global cesarean section rates rising, there's concern about increase in obstetric vesico-uterine fistula (OVUF). Very little is known about this anatomoclinical entity of obstetric fistula in Africa in general and in DRC in particular. Our purpose was to describe the epidemiological, clinical, and therapeutic aspects of OVUF in the Democratic Republic of the Congo (DRC). METHODS This was a descriptive cross-sectional study. Data were collected from patients who presented with OVUF across seven provinces of the DRC (North Kivu, Haut-Uélé, Kasai Central, Kwilu, Maniema, Nord-Ubangi and Sankuru) from January 2017 to December 2022. Study variables were epidemiological, clinical, and therapeutic features. RESULTS Of 1,267 patients presenting with obstetric fistulas, 355 (28.0%) had OVUF. The mean age was 32.9 ± 11.6 years, 80.6% of patients (286/355) lived in rural areas, and the majority had a low level of education (40% no formal education, 30.1% primary school, 28.7% secondary school). In total, 64.8% of patients were primiparous (230/355) and in all (100%) cases, OVUF was caused iatrogenically during cesarean delivery. Majority (76.3%) of patients laboured for one day or less (mean duration 1.0 ± 0.5 days) before giving birth, and the fetus died in 58.3% of cases. In 35.8% of cases, the fistula had lasted more than 10 years (mean age 10.1 ± 10.0 years) before repair. A proportion of 88.2% (n = 313) of OVUF was isolated while 11.3% (n = 40) was associated with a uretero-vaginal fistula. In 82.8% (n = 294) of cases the OVUF was single. The average fistula size was 2.4 ± 1.0 cm (range: 0.5 and 5.5 cm) and 274 (77.2%) fistulas measured between 1.5 and 3 cm, with 14.9% (n = 53) of them larger than 3 cm. Fibrosis was present in 65.1% of cases, cervical involvement was absent in 97.7% and post-operative complications were absent in 94.4%. In all cases, the OVUF was surgically repaired abdominally with a success rate of 97.5% (346/355). CONCLUSION The proportion of OVUF is relatively high in the DRC. Most affected patients were young, under-educated, primiparous women living in rural areas. Cesarean section was the sole identified cause of OVUF which was isolated, single, without fibrosis, in majority of cases. Abdominal repair of OVUF was very effective, with good results in almost all cases. Teaching young doctors working mainly in remote areas how to perform safe cesarean section is needed to reduce incidence of OVUF in DRC.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo.
| | - Cathy Mufungizi Furaha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - Benjamin Kasereka Kataliko
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - Jonathan Ml Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - Benjamin Kambale Kalole
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, DRC, Democratic Republic of the Congo
| | - John Kasereka Muteke
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
| | - Michel Mulyumba Kyembwa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
| | - Richard Kabuseba Kabuyanga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, DRC, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Departments of Pediatrics and Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, DRC, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, DRC, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, DRC, Democratic Republic of the Congo
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A rare urogenital fistula with minimally invasive management. Eur J Obstet Gynecol Reprod Biol 2021; 258:470-471. [PMID: 33431238 DOI: 10.1016/j.ejogrb.2020.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022]
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Robotic repair of the symptomatic vesicouterine fistula. Int Urogynecol J 2020; 32:1945-1947. [PMID: 33078342 PMCID: PMC8295101 DOI: 10.1007/s00192-020-04558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/02/2020] [Indexed: 11/20/2022]
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Armstrong H, Thistle P. Vesicouterine Fistula and Fetus in Bladder: A Case Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:634-636. [PMID: 31679917 DOI: 10.1016/j.jogc.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Vesicouterine fistulas are the rarest of all urogenital fistulas, with most cases occurring after cesarean section. CASE A 38-year-old woman in rural Zimbabwe presented at 20 weeks gestation with a suspected fetus in the urinary bladder by transabdominal ultrasonography. This finding was confirmed intraoperatively together with a vesicouterine fistula. Cesarean section 20 years earlier was the only risk factor. Diagnosis was delayed for lack of access to appropriate imaging and a tertiary facility. CONCLUSION A vesicouterine fistula is a rare presentation in the context of an advanced health care system. To our knowledge, this is the fourth case report of a fetus in the bladder secondary to vesicouterine fistula. Patient morbidity in this case possibly could have been avoided with earlier diagnosis and access to care.
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Affiliation(s)
- Heather Armstrong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC.
| | - Paul Thistle
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe; Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON
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Jóźwik M, Jóźwik M, Zaręba K, Semczuk A, Modzelewska B, Jóźwik M. Congenital vesicouterine fistulas-A PRISMA-compliant systematic review. Neurourol Urodyn 2018; 37:2361-2367. [PMID: 30106189 DOI: 10.1002/nau.23795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Abstract
AIMS Vesicouterine fistulas (VUFs) are infrequent abnormal connections between the bladder and the uterine cavity or cervical canal, being mainly sequelae of repeat Cesarean sections. Exceedingly rare are congenital VUFs. This is a systematic review of available world data aimed to characterize congenital VUFs and better understand the mechanism(s) of their formation. METHODS The PubMed® database via MEDLINE® search engine was explored from its inception to March 2018. Relevant studies were identified using selected Medical Subject Heading-based terms. This was further supplemented by cross-referencing and handsearching. Retrieved literature was evaluated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. RESULTS A total of 6561 articles were identified of which 10 were analyzed. Three VUFs accompanied broader syndromes of congenital defects. A lack of patency at the level of the vagina was present in all assessed cases. Unilateral renal agenesis was confirmed in four of eight (50%) verified patients. Hence, unilateral kidney agenesis was related to a lesser degree (P = 0.0186) than vaginal atresia to VUF. The principal features of these fistulas were as follows: partial or complete vaginal atresia resulting in primary amenorrhea, menouria present since menarche, and urinary continence. CONCLUSIONS This review provides the first systematic evidence that congenital VUFs are chiefly associated with concomitant vaginal atresia. The symptomatology of such VUFs is consistent with that of type I acquired fistulas.
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Affiliation(s)
- Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland
| | - Marcin Jóźwik
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Kamil Zaręba
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland
| | - Andrzej Semczuk
- IIND Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Beata Modzelewska
- Department of Biophysics, Medical University of Białystok, Białystok, Poland
| | - Michał Jóźwik
- Chair of Clinical Sciences, Faculty of Health Sciences, State Higher School of Computer Science and Business Administration, Łomża, Poland
- Department of Reproductive Health, National Research Institute of Mother and Child, Warsaw, Poland
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Early Robotic Repair of Vesicouterine Fistula: A Case Report and Literature Review. Urol Case Rep 2017; 11:76-78. [PMID: 28224086 PMCID: PMC5310202 DOI: 10.1016/j.eucr.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 11/24/2022] Open
Abstract
As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Early robotic-surgery offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. 42 years old female day 12 post-LSCS in author hospital with history of bladder injury and folly's catheter in place since OR complain of gross hematuria for 8 days.
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Lesovoy V, Parashchuk Y, Shchukin D, Safonov R, Didenkova K, Lisova M, Safonova I. Fetus in the Bladder: Rare Complication of Vesicouterine Fistula. Case Rep Med 2016; 2016:5750710. [PMID: 28105051 PMCID: PMC5220462 DOI: 10.1155/2016/5750710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022] Open
Abstract
The work presents a rare case of spontaneous migration of an 11-week fetus from the uterine cavity into the urinary bladder cavity through the long-standing vesicouterine fistula.
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Affiliation(s)
- Vladimir Lesovoy
- Kharkiv National Medical University, 4 Nauky Avenue, Kharkiv 61022, Ukraine
- V.I. Shapoval Regional Clinical Center of Urology and Nephrology, 195 Moskovskyy Avenue, Kharkiv 61037, Ukraine
| | - Yuryi Parashchuk
- Kharkiv National Medical University, 4 Nauky Avenue, Kharkiv 61022, Ukraine
| | - Dmytro Shchukin
- Kharkiv National Medical University, 4 Nauky Avenue, Kharkiv 61022, Ukraine
- V.I. Shapoval Regional Clinical Center of Urology and Nephrology, 195 Moskovskyy Avenue, Kharkiv 61037, Ukraine
| | - Roman Safonov
- Regional Clinical Hospital, Center of Emergency Medical Care and Disaster Medicine, 13 Pravdy Avenue, Kharkiv 61022, Ukraine
| | - Karyna Didenkova
- V.I. Shapoval Regional Clinical Center of Urology and Nephrology, 195 Moskovskyy Avenue, Kharkiv 61037, Ukraine
| | - Maria Lisova
- Kharkiv National Medical University, 4 Nauky Avenue, Kharkiv 61022, Ukraine
| | - Inessa Safonova
- Kharkiv Medical Academy of Postgraduate Education, 58 Amosova Street, Kharkiv 61176, Ukraine
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Sato T, Sato N, Takahashi K, Kito M, Sugawara T, Kato A, Makino K, Shimizu D, Terada Y. Cesarean scar caseating granuloma: a case of vesicouterine fistula 30 years after cesarean section. Clin Case Rep 2016; 4:721-4. [PMID: 27525069 PMCID: PMC4974413 DOI: 10.1002/ccr3.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/15/2016] [Accepted: 05/18/2016] [Indexed: 11/05/2022] Open
Abstract
A mass developing in operating scar part with fistula should raise concern for caseating granuloma even if many years after operation.
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Affiliation(s)
- Toshiharu Sato
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Naoki Sato
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Kazue Takahashi
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Masahiko Kito
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Tae Sugawara
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Aya Kato
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Kenichi Makino
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Dai Shimizu
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
| | - Yukihiro Terada
- Department of Obstetrics and Gynecology Akita University School of Medicine 1‐1‐1 Hondo Akita 010‐8543 Japan
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The use of an anterior abdominal wall peritoneal flap in the laparoscopic repair of vesicouterine fistula. Int Surg 2016; 99:673-6. [PMID: 25216441 DOI: 10.9738/intsurg-d-13-00148.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vesicouterine fistula (VUF) is a rare type of genitourinary fistula. Lower-segment cesarean section is the leading cause of VUF. Patients mostly present with the classical triad of menouria, amenorrhea, and urinary incontinence, with the history of a previous cesarean section. Conservative management with catheterization and open, laparoscopic, and robotic surgeries are the prescribed treatment options. We present the case of a 35-year-old woman who presented with cyclical menouria and urinary incontinence. After diagnosis of VUF by cystoscopy, the laparoscopic approach was chosen. During the procedure, we used anterior abdominal wall peritoneum and adjacent adipose tissue interposition for the first time, instead of omental interposition, because of the unavailability of omentum. The postoperative period was uneventful, and the procedure was successful. In conclusion, the laparoscopic approach is feasible and the anterior abdominal wall peritoneal flap can be used instead of omentum for tissue interposition when the omentum is not available.
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Youssef's Syndrome following Cesarean Section. Case Rep Obstet Gynecol 2015; 2015:605325. [PMID: 26457214 PMCID: PMC4589585 DOI: 10.1155/2015/605325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/06/2015] [Indexed: 11/17/2022] Open
Abstract
Youssef's 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. Youssef's syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature.
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Geoffrion R, Hyakutake MT. Timing cervicovesical fistula repair with repeat cesarean section. Int Urogynecol J 2014; 25:1145-7. [PMID: 24522933 DOI: 10.1007/s00192-013-2323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
We present a case in which there was optimal management of recurrent cervicovesical fistula. The patient sustained a fistula shortly after a cesarean for cephalopelvic disproportion in the second stage. She underwent an unsuccessful attempt at vaginal repair 3 months postpartum and continued experiencing intermittent urinary leakage through the vagina. She expressed a wish for further childbearing and was counseled to undergo fistula repair at the time of repeat cesarean section. Twenty-seven months after her first delivery, she had a second healthy pregnancy and the repair of her cervicovesical fistula was performed with collagen graft interposition at the time of her elective cesarean section. This case report highlights the importance of surgical timing and comments on various factors that possibly enhance the success of the fistula repair.
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Affiliation(s)
- Roxana Geoffrion
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada,
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Ugurlucan FG, Bastu E, Bakir B, Yalcin O. Vesicouterine fistula presenting with urinary incontinence 30 years after primary Cesarean: Case report and review of the literature. Can Urol Assoc J 2014; 8:E48-50. [PMID: 24454601 DOI: 10.5489/cuaj.1225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A vesicouterine fistula is an abnormal communication between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be applied in some cases, but surgery is the definitive treatment. We present a 55-year-old woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence 30 years later. Methylene blue dye test was performed and drainage of urine dyed with methylene blue through the uterine cervix was observed. Diagnosis was confirmed with magnetic resonance imaging. Total abdominal hysterectomy and bilateral oophorectomy was performed and the bladder wall was sutured in a double layer with 2/0 polyglycolic suture. No complications developed and the patient did not suffer from any urinary incontinence afterwards. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section; diagnostic tests and, if necessary, appropriate surgery should be performed.
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Affiliation(s)
- Funda Gungor Ugurlucan
- Istanbul University Istanbul School of Medicine Department of Obstetrics and Gynecology, Turkey
| | - Ercan Bastu
- Istanbul University Istanbul School of Medicine Department of Obstetrics and Gynecology, Turkey
| | - Baris Bakir
- Istanbul University Istanbul School of Medicine Department of Obstetrics and Gynecology, Turkey
| | - Onay Yalcin
- Istanbul University Istanbul School of Medicine Department of Obstetrics and Gynecology, Turkey
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Shephard SN, Lengmang SJ. The missing foley catheter: an unusual finding in vesicouterine fistula. J Surg Case Rep 2013; 2013:rjt115. [PMID: 24968444 PMCID: PMC3888006 DOI: 10.1093/jscr/rjt115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 28-year-old G1P1 presented complaining of urine leakage per vaginum following caesarean delivery, accompanied by amenorrhoea, cyclic haematuria and cyclic pelvic pain. Examination findings were suggestive of vesicouterine fistula and the patient was taken for exploratory laparotomy, during which the foley catheter could not be identified within the bladder. During separation of the bladder from the uterus, the catheter was found to be traversing the fistulous tract into the uterine cavity. Vesicouterine fistula is a fairly uncommon type of urogenital fistula that is frequently associated with caesarean section. Surgical treatment remains the mainstay and successfully cured this patient.
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Affiliation(s)
- Steven N Shephard
- Evangel VVF Center, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Sunday J Lengmang
- Evangel VVF Center, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria
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15
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Sung HH, Park BH, Ryu DS, Lee KS. Recent advances in robotic surgery in female urology. Int J Urol 2013; 20:1154-62. [PMID: 23859651 DOI: 10.1111/iju.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/11/2013] [Indexed: 11/29/2022]
Abstract
Pelvic organ prolapse and lower urinary tract fistulas are two disorders frequently managed in female urology. New techniques have been adapted and improved to decrease morbidity and improve clinical outcomes of these disorders. The adaptation of minimally-invasive approaches for the management of pelvic organ prolapse and lower urinary tract fistulas began with laparoscopy. However, laparoscopic surgery has not gained widespread popularity as a result of the associated technical challenges, such as intracorporeal suturing and pelvic dissection. Robotic surgery has been widely carried out in urological oncology since 2001, and has been widely adapted because of its advantages over conventional laparoscopy for the management of pelvic organ prolapse and lower urinary tract fistulas. The current literature has shown the safety, feasibility and favorable clinical outcomes of robotic surgery for the treatment of these disorders. Robotic surgery in the management of pelvic organ prolapse and lower urinary tract fistula repairs might offer a promising advancement and benefits. However, further long-term data should be followed to assess the durability of this newer, and minimally-invasive approach.
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Affiliation(s)
- Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abdel-Karim AM, Elmissiry M, Aboulfotoh A, Moussa A, Elsalmy S. Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience. Int Urol Nephrol 2013; 45:995-1000. [DOI: 10.1007/s11255-013-0467-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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17
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Rajamaheswari N, Chhikara AB. Vesicouterine fistulae: our experience of 17 cases and literature review. Int Urogynecol J 2012; 24:275-9. [DOI: 10.1007/s00192-012-1798-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/11/2012] [Indexed: 11/24/2022]
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Tsivian M, Tsivian M, Sidi AA, Tsivian A. Uretero-vesico-cervical fistula following a caesarean section: a unique case report. Int Urogynecol J 2012; 23:1639-41. [PMID: 22527547 DOI: 10.1007/s00192-012-1748-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
Abstract
A unique combined fistula involving simultaneously the bladder, ureter, and cervix following cesarean section is described. Evaluation, management, and review of the literature regarding this rare and challenging case are reported. This unique case report emphasizes the potential complexity of iatrogenic genitourinary fistulae, suggesting that these might have unexpected morphology and present with multiple fistulous components. It has been demonstrated that concomitant ureteral involvement is estimated to complicate at least 10 % of vesico-vaginal fistulae. Thus, increased awareness of the possibility of complex iatrogenic fistulae and precise evaluation of the upper urinary tract are necessary to accurately define the extent of all fistulous tracts during the initial evaluation. This in turn may enable tailored management of these challenging cases. Moreover, in the case of surgical treatment, an accurate initial definition of fistula morphology may enable a single-stage reconstructive procedure sparing additional interventions and avoiding any potential complications.
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Affiliation(s)
- Maria Tsivian
- Department of Urologic Surgery, E. Wolfson Medical Center, Holon, Israel
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A case with vesicouterine fistula: mini review. Arch Gynecol Obstet 2012; 285:667-70. [DOI: 10.1007/s00404-011-2188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
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Mahmoud B, Sataa S. Post-cesarean Vesicouterine Fistulae: A Report on a Case and an Update of the Literature. ACTA ACUST UNITED AC 2012. [DOI: 10.3834/uij.1944-5784.2012.08.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Results of this study suggest that computer-enhanced technology may provide a
bridge for more surgeons to incorporate laparoscopic surgery in the management
of complex cases. Background: As cesarean sections become a more common mode of delivery, they have become
the most likely cause of vesicouterine fistula formation. The associated
pathology with repeat cesarean deliveries may make repair of these fistulas
difficult. Computer-enhanced telesurgery, also known as robotic-assisted
surgery, offers a 3-dimensional view of the operative field and allows for
intricate movements necessary for complex suturing and dissection. These
qualities are advantageous in vesicouterine fistula repair. Case: A healthy 34-year-old woman who underwent 4 cesarean deliveries presented
with a persistent vesicouterine fistula. Conservative management with
bladder decompression and amenorrhea-inducing agents failed. Results: Robotic-assisted laparoscopic repair was successfully performed with the
patient maintaining continence after surgery. Conclusion: Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a
minimally invasive approach to treatment of a complex disease process.
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Affiliation(s)
- Shao-Chun R Chang-Jackson
- Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, Academic Affiliate of Columbia University, College of Physicians and Surgeons, New York, New York, USA
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Arora P, Mullan C, Lawton V. Post-caesarean vesico-uterine fistula leading to puerperal sepsis. J OBSTET GYNAECOL 2010; 30:415. [PMID: 20455734 DOI: 10.3109/01443611003759265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P Arora
- Department of Obstetrics and Gynaecology, Hope Hospital, Salford Royal NHS Foundation Trust, Salford, UK.
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Fenkci IV, Demirbas M, Oztekin O. Sonohysterography in evaluation of Youssef’s syndrome. Int Urogynecol J 2009; 21:607-8. [DOI: 10.1007/s00192-009-1029-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 10/11/2009] [Indexed: 10/20/2022]
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El-Lamie IK. Urogenital fistulae: changing trends and personal experience of 46 cases. Int Urogynecol J 2007; 19:267-72. [PMID: 17639345 DOI: 10.1007/s00192-007-0426-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 06/28/2007] [Indexed: 10/23/2022]
Abstract
A retrospective study of 46 patients with different types of urogenital fistulae treated by the author during the period from January 1997 to December 2006 is presented. Twenty-two (48%) cases had a vesicovaginal fistula of which 16 (73%) were repaired vaginally and 6 (27%) were repaired abdominally. The remaining fistulae were as follows: 14 (30%) unilateral ureterovaginal fistulae, 6 (13%) ureterovesicovaginal fistulae (one bilateral), and 4 (9%) vesicouterine fistulae. All were repaired abdominally except for one patient with ureterovesicovaginal fistula needing continent urinary diversion using Mainz type II pouch. All fistulae were iatrogenic except one case (2%) which was due to neglected obstructed labor. The iatrogenic causes were gynecologically related in 26 (57%) patients and obstetrically related in 19 (41%) cases. There were two (9%) failed repairs in the vesicovaginal cases, one in each group, and both were salvaged by a secondary surgery. In view of this selected retrospective study and in association with other reports, it seems that with the improvement in the basic health-care services in Egypt, there is a change in the etiology of urogenital fistulae with the vast majority being physician related and no more related to neglected obstructed labor. Such shortcoming should be addressed in the current gynecological surgery training and residency programs.
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Affiliation(s)
- Ismail K El-Lamie
- Department of Obstetrics & Gynecology, Ain Shams University, Cairo, Egypt.
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DiMarco CS, DiMarco DS, Klingele CJ, Gebhart JB. Vesicouterine fistula: a review of eight cases. Int Urogynecol J 2006; 17:395-9. [PMID: 16523247 DOI: 10.1007/s00192-005-0025-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 09/18/2005] [Indexed: 11/28/2022]
Abstract
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. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2-24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.
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Affiliation(s)
- Connice S DiMarco
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Novi JM, Rose M, Shaunik A, Ramchandani P, Morgan MA. Conservative management of vesicouterine fistula after uterine rupture. Int Urogynecol J 2004; 15:434-5. [PMID: 15549264 DOI: 10.1007/s00192-004-1165-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 03/15/2004] [Indexed: 11/28/2022]
Abstract
We report the closure of a vesicouterine fistula with conservative management utilizing an indwelling transurethral Foley catheter. Uterine rupture occurred during a trial of vaginal birth after cesarean section, necessitating an emergency cesarean section. Upon entry into the abdomen, the base of the bladder was noted to be involved in the uterine rupture. The bladder trigone and ureteral orifices appeared normal. A primary, two-layer bladder repair was performed. A cystogram on postoperative day 14 demonstrated a vesicouterine fistula. Conservative management involving bladder drainage for 21 days with a transurethral Foley catheter was successful in closure of the fistula. Vesicouterine fistula, a documented complication of uterine rupture due to attempted vaginal birth after previous cesarean section, can spontaneously resolve with conservative management alone.
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Affiliation(s)
- Joseph M Novi
- Department of Obstetrics and Gynecology, University of Pennsylvania, 5 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Porcaro AB, Zicari M, Zecchini Antoniolli S, Pianon R, Monaco C, Migliorini F, Longo M, Comunale L. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Int Urol Nephrol 2004; 34:335-44. [PMID: 12899224 DOI: 10.1023/a:1024443822378] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Herein we report on 1 more case of vesicouterine fistula following cesarean section with review and update of the literature concerning this unusual topic. The disease presented with vaginal urinary leakage, cyclic hematuria and amenorrhea. The fistula was successfully repaired by delayed surgery. Actually, all over the world the prevalence of the disease is increasing for the frequent use of the cesarean section. Fistulas may develop immediately after a cesarean section, manifest in the late puerperium or occur after repeated procedures. Spontaneous healing is reported in 5% of cases. Vesicouterine fistulas present with vaginal urinary leakage, cyclic hematuira (menouria), amenorrhea, infertility, and first trimester abortions. The diagnosis is ruled out by showing the fistulous track between bladder and uterus as well as by excluding other more frequent urogenital fistulas. The disease treatment options include conservative treatment as well as surgical repair. Rarely, patients refuse any kind of treatment because of the benignity of symptoms and prognosis of the disease. Conservative management by bladder catheterization for at least 4-8 weeks is indicated when the fistula is discoveredjust after delivery since there is good chance for spontaneous closure of the fistulous track. Hormonal management should be tried in women presenting with Youssef's syndrome. Surgery is the maninstay and definitive treatment of vesicouterine fistulas after cesarean section. Patients scheduled for surgery should undergo pretreatment of urinary tract infections. Surgical repair of vesico-uterine fistulas are performed by different approaches which include the vaginal, transvesical-retroperitoneal and transperitoneal access which is considered the most effective with the lowest relapse rate. Recently, laparoscopy has been proposed as a valid option for repairing vesicouterine fistulas. The endoscopic treatment may be effective in treating small vesicouterine fistulas. The pregnancy rate after repair is 31.25% with a rate of term deliveries of 25%. The disease may be prevented by emptying the bladder as well as by carefully dissecting the lower uterine segment. It is advisable that after vesicouterine fistula repair delivery should be performed by repeating a cesarean section since the risk of fistula recurrence. Usually, vesicouterine fistulas are diagnosed postoperatively. As a result, at least 95% of patients will undergo another operation for repairing the fistula. In the meantime they are bothered by related symptoms which impair their quality of life. As far as we are concerned intraoperative diagnosis is the gold standard in detecting vesicouterine fistulas for allowing immediate repair. We propose intraoperative sonography by the transvaginal (or transrectal) route for the Foley transurethral 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. As a result patients will avoid the familial and social problems related to the disease as well another operation. Moreover, ultrasound Doppler examination may help in better investigating and understanding the pathophysiology of vesicouterine fistulas.
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Medina Ramos N, Cerezuela Requena JF, Martín Martínez A, García Hernández JA, Chesa Ponce N. [Vesico-uterine fistula, a rare complication of cesarean section]. Actas Urol Esp 2003; 27:244-7. [PMID: 12812125 DOI: 10.1016/s0210-4806(03)72913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present the case of a vesicouterine fistula secondary to a caesarean section indicated due to the disproportion the pelvis and the head of the baby. This kind of fistula is due fundamentally to obstetric causes, especially to caesarean sections in developed countries and to prolonged labour in developing countries. The commonest clinical presentation is urinary incontinence in the form of continuous or intermittent urinary leaks. Surgical treatment is generally the therapy of choice, although, in the case of small fistulas, conservative treatment is feasible. The best form of prevention is correct indication of caesarean section and careful surgical technique.
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Affiliation(s)
- N Medina Ramos
- Servicio de Obstetricia y Ginecología, Hospital Universitario Materno Infantil de Canarias
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Bonillo García MA, Pacheco Bru JJ, Palmero Martí JL, Alapont Alacreu JM, Alonso Gorrea M, Arlandis Guzmán S, Jiménez Cruz JF. Fístulas vesicouterinas. nuestra experiencia tras 25 años. Actas Urol Esp 2003; 27:707-12. [PMID: 14626680 DOI: 10.1016/s0210-4806(03)73000-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used. MATERIAL AND METHODS We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up. RESULTS 6 cases of vesicouterine fistulae were evaluated. In 83.3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36.5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery. CONCLUSIONS The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula.
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Cystoscopic Fistulography. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200112000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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HEMAL A, KUMAR RAJEEV, NABI GHULAM. POST-CESAREAN CERVICOVESICAL FISTULA: TECHNIQUE OF LAPAROSCOPIC REPAIR. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66457-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- A.K. HEMAL
- From the Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - RAJEEV KUMAR
- From the Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - GHULAM NABI
- From the Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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