Vesicouterine fistula presenting with cyclical haematuria mimicking bladder endometriosis: A case report

Surgical repair of post-cesarean vesicouterine fistula: A systematic review and a plea for prevention

BACKGROUND

Vesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.

OBJECTIVES

To assess current evidence on VUF pathogenesis and surgical management.

SEARCH STRATEGY

Pubmed and Embase databases were searched from January 2000 to January 2023 using relevant key words.

SELECTION CRITERIA

Only original articles including either transabdominal or transvaginal surgical routes for post-cesarean VUF repair, in English language, were included.

DATA COLLECTION AND ANALYSIS

Two authors independently screened the references for eligibility, data extraction, and assessment of methodologic quality. All available surgical outcomes were recorded.

MAIN RESULTS

Of the 1160 studies retrieved, 67 were selected for analysis. Most of these were case reports, case series, or observational cohort studies including a total of 284 patients. The majority (78.6%) of patients had more than one cesarean section, and approximately 10% of them experienced an overt bladder injury and/or uterine rupture at the time of cesarean delivery. The supratrigonal part of the bladder was most commonly involved (92.5%). The majority of patients (88.8%) underwent delayed VUF repair through laparotomy. Length of stay and blood loss were significantly less in patients treated via a minimally invasive approach (P < 0.001 and P = 0.02, respectively). Most patients had double-layer bladder repair and single-layer uterine repair. The overall success rate was 100% on first attempt for each independent combination of different surgical approaches and techniques. Live birth following VUF repair was reported in 23 patients.

CONCLUSIONS

Paying close attention to surgical details is crucial to reduce the incidence of this complication and recurrence rates. Double-layer bladder closure and delayed timing of repair of VUF are recommended.

Trans-intrauterine contrast-enhanced ultrasound (CEUS) can be an effective approach for the diagnosis of vesicouterine fistula (VUF), especially for patients with fistulas flowing unidirectionally from the uterine cavity

Background

Vesicouterine fistula (VUF) is a rare complication after cesarean section. It is challenging to diagnose VUF correctly.

Case presentation

A 34-year-old woman complained of recurrent hematuria and urinary tract infection for more than 4 years after cesarean delivery, mostly during menstruation, without vaginal leakage and with a normal menstrual cycle. Conventional transabdominal ultrasound showed no abnormal findings in bilateral kidneys and ureters, bladder and uterus, and transvaginal ultrasound showed that the scar at the lower part of the anterior uterine wall was closely adhered to the posterior wall of the bladder. Considering that the patient had hematuria but no vaginal leakage, we assumed that the fistula was flowing unidirectionally from the uterine cavity to the bladder cavity. Therefore, we chose to inject SonoVue (ultrasound contrast agent) into the uterine cavity rather than into the bladder. After intrauterine injection of SonoVue, the ultrasound contrast agent was seen flowing from the uterine cavity into the bladder cavity through the fistula, showing a hyperechoic fistula between the posterior wall of the bladder and the uterine wall, confirming the diagnosis of VUF. The accuracy of this diagnosis was then further confirmed by both MRI and cystoscopy.

Conclusions

Trans-intrauterine CEUS provides a new effective imaging method for the diagnosis of VUF, especially for patients with fistulas that flow unidirectionally from the uterine cavity.

Uterovesical Fistula as an Uncommon Complication Following Cesarean Delivery: A Case Report

Uterovesical fistula (UVF) represents a rare and undesirable complication of cesarean section. It is the least common type of urogenital fistulae. Here we report a 41-year-old woman who presented with a four-year history of cyclical menouria and secondary infertility. After she resumed her regular menstrual cycles six weeks following her fourth cesarean delivery, she started to recognize the passage of blood with urine with each cyclical vaginal bleeding. The diagnosis of UVF was made through ultrasonography, hysterosalpingography (HSG) and cystoscopy. Being a large-diameter fistula, a successful surgical repair with the traditional open surgery was done and the fistulous tract was completely excised. Recovery was uneventful. There was no more menouria after fistula repair.

A neglected cervicovesical fistula diagnosed and repaired by combined hysteroscopy and laparoscopy: A case report and review of literature

Objective

To analyze a case of neglected cervicovesical fistula with intrauterine adhesions caused by cesarean section.

Methods

A 36-year-old female patient with a history of two previous cesarean sections complained of the absence of menstruation for the last 18 months. The diagnosis of the cervicovesical fistula was made through hysteroscopy and cystoscopy. The reconstruction of the uterus and bladder was achieved by a laparoscopic repair technique.

Results

The patient resumed normal menstruation postoperatively without complaining of any complications. Uterine continuity and cavity had been restored to normal at the second look of hysteroscopy.

Conclusions

Cervicovesical fistula with intrauterine adhesions is very rare in our clinical work. Hysteroscopy might play an essential role in diagnosing cervicovesical fistula and IUA. In our literature review, a surgical approach was the mainstay and definitive management of the cervicovesical fistula following a cesarean section.