Vesicouterine fistula after cesarean section: ultrasonographic findings in two cases

Ultrasound in the Diagnosis of Malignant Pelvic Fistulas: Sonographic Findings in Correlation with Computed Tomography Imaging

Even though ultrasound is an extensively used imaging modality, it has not been effectively utilized in the evaluation and diagnosis of malignant pelvic fistulas. In this study, we tried to correlate the accuracy of sonographic findings in identifying malignant fistulas with that of computed tomography (CT) imaging. Thirty-five patients with advanced pelvic malignancies were examined over a period of 2 y. Patients underwent CT of the abdomen and pelvis with intravenous and oral/rectal contrast followed by ultrasound of the abdomen. Sonographic examinations were performed using a standardized protocol with a full bladder. Real-time ultrasound images of the abdomen and pelvis in multiple planes were acquired and stored as both image files and audio-video interleaves (AVIs). On ultrasound, the majority of the fistulas were visualized either as a continuous hyper-echoic tract within a hypo-echoic neoplastic mass ("air contrast sign") or as multiple discontinuous hyper-echoic foci with "ring down" artifacts. The sensitivity and specificity of ultrasound in the detection of malignant fistulas were 72% (confidence interval [CI]: 52%-87%) and 66% (CI: 22%-95%), respectively. We also reviewed the literature and compared the sensitivities of ultrasound in the detection of various types of pelvic fistulas obtained in previous studies with those in the present study. Results suggest that although ultrasound cannot be used as a primary imaging modality for the detection of fistulas, it can provide the earliest clue to the presence of a malignant fistula.

Urinary bladder fistulae and the role of CT cystography: a pictorial review

Various conditions such as inflammation, malignancy, surgical manipulations, and radiation therapy can lead to the development of urinary bladder fistulae. Although many of these fistulae are suspected clinically, imaging plays a major role in confirmation and planning of subsequent treatment. Computed tomography (CT) cystoscopy provides useful details regarding the fistulous track and the anatomy of the region. This article aims to provide a succinct review of bladder fistulae and the role of CT cystography in their management.

A Case of Type 2 Youssef's Syndrome following Caesarean Section for Placenta Previa Totalis

Vesicouterine fistula is a rare type of urogenital fistulas. It is most commonly observed after cesarean section (C/S) due to iatrogenic reasons. In this article, a case of a vesicouterine fistula which developed after C/S operation is presented. This was the patient's second C/S and this time placenta previa totalis was the primary pathology. Since it is a rare complication, we found it interesting, and, in this article, this clinical problem was discussed with details about diagnosis and treatment in light of the literature.

Youssef's Syndrome following Cesarean Section

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.

Management of genitourinary fistula

PURPOSE OF REVIEW

To review current literature on the management of genitourinary fistulae, specifically, the techniques for diagnosis, timing to repair, surgical approach and recent advancements in surgical technique.

RECENT FINDINGS

Recent advancement in minimally invasive surgery has prompted surgeons to perform fistula repairs with laparoscopic or robotic-assisted laparoscopic techniques. Whereas there is a role for transabdominal fistula closure, the majority of fistulae are still best approached via a transvaginal route.

SUMMARY

Genitourinary fistulae from obstetric trauma have received increased attention and funding to treat and prevent this devastating condition in developing countries. Despite multiple classification systems, a standardized classification that accurately identifies predictors of successful repair is lacking. In industrialized nations, genitourinary fistulae are rare and are most frequently associated with pelvic surgery, pelvic radiation, cancer or trauma. Surgical techniques to repair these fistulae have shifted from transabdominal laparotomy to minimally invasive laparoscopic procedures. Vascularized tissue flaps can play an important role in successful closure of complex fistulae. Despite advancements in surgical technology, overarching principles of fistula closure remain. The majority of fistulae can be closed through a transvaginal approach, with a tension-free, watertight, multilayer closure.

Fetus in bladder

This is the first reported case of vesicouterine fistula presenting with a fully formed dead fetus in the urinary bladder.

Radiological diagnosis of vesicouterine fistula: role of magnetic resonance imaging

PURPOSE

To retrospectively assess the value of magnetic resonance imaging (MRI) in the diagnosis of vesicouterine fistula (VUF).

MATERIALS AND METHODS

Between January 2003 and January 2011, 12 patients with a diagnosis of VUF were surgically managed at our center; among them, eight patients had MRI among their preoperative radiological investigations and those were included in our study. The clinical presentation, radiological investigations, and surgical findings of the patients were reviewed.

RESULTS

The mean age of the patients was 31 years. Seven of the eight patients had complaints of cyclic hematuria and the remaining patient complained of urinary leakage through the vagina. The etiology of VUF was cesarean section in all patients. The preoperative radiological investigations included conventional cystography in five patients, intravenous urography in two, computed tomography (CT) urography in two, and MRI in eight. The sensitivities of diagnosis for these investigations were 40%, 0%, 50%, and 100%, respectively.

CONCLUSION

In our small retrospective series, pelvic MRI was reliable and sensitive for diagnosis of VUF. It should be considered in the work-up of patients with suspected VUF.

Late post-cesarean surgical complication

AIM

The aim of the study was to clarify the incidence, indication, and management of late surgical intervention following cesarean section (CS) in a tertiary care university hospital.

METHODS

A cohort of 5981 women underwent CS from a group of 24,060 parturients in a retrospective study at a tertiary care university hospital. Surgical intervention after CS in the late postoperative period (after puerperium) was reviewed regarding clinical, operative, and pathological findings.

RESULTS

The CS rate was 24.86%. The incidence of late surgical intervention after CS was 0.40% (24/5981); of these 24 women, 10 (41.67%) were operated for skin lesions, two (8.3%) for urogenital fistula, three (12.5%) for gastrointestinal problems, three (12.5%) for omental masses and six (25%) for pelvic lesions.

CONCLUSION

Although the incidence of surgical intervention after CS in the late postoperative period is low and the outcome is favorable, several measures must be undertaken to reduce late surgical complications.

Vesicouterine fistula following Cesarean delivery--ultrasound diagnosis and surgical management

Vesicouterine fistulae are uncommon, with most units reporting 1-5 cases over 5-15-year periods. To date there has been a paucity of case reports regarding this problem and only a few case series. In this report we outline the presentation and management of a vesicouterine fistula complicating a repeat Cesarean delivery, specifically describing the role of transvaginal ultrasound.

Sonographic diagnosis of vesicouterine fistula

Vesicouterine fistula is one of the least common types of urogenital fistula, accounting for only 1-4% of all cases. We report a case of vesicouterine fistula after vacuum delivery in a woman with a history of a previous Cesarean section. The 29-year-old woman was hospitalized due to continuous serosanguinous vaginal leakage and hematuria. Transvaginal sonography demonstrated the presence of a fistulous tract between the uterus and the bladder. Cystoscopy demonstrated a small opening in the posterior bladder wall and a cystogram revealed a fistulous tract between the posterior portion of the bladder and the uterine cavity. Since the patient could not tolerate her symptoms, we decided to close the fistulous tract surgically. The fistulous tract was excised and the bladder and uterus were closed primarily. The bladder was drained with a Foley catheter for 12 days and subsequent follow-up of the patient has demonstrated urinary continence.

Pelvic fistulas complicating pelvic surgery or diseases: spectrum of imaging findings

Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.