- VUF is the least common urogynecological fistulae (1–4%)
A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The first case was reported by Knipe and colleagues in 1908. In 1957, Youssef described a syndrome comprising of cyclic hematuria, amenorrhea, menouria, and complete urinary incontinence in a patient who had lower segment Cesarean section (LSCS). In previous years, it used to be regarded as a complication of assisted delivery applications like vacuum and forceps techniques. Today, 83–93% of VUFs are observed after caesarean delivery
VUF clinical classification:Based on the routes of menstrual flow
- Type 1: Triad of amenorrhea, menouria (cyclic hematuria) and complete continence of urine “Youssef’s syndrome” (M/C, 90% cases)
- Type 2: Dual menstrual flow through both the bladder and vagina)
- Type 3: Normal vaginal menses and lack of menouria)
- LSCS (M/C, 83–93% cases)
- High vaginal forceps-aided delivery
- External cephalic version
- Curettage/manual removal of placenta
- Placenta percreta
- Uterine rupture due to obstructed labor
- Uterine artery embolization (UAE)
- Perforation of intrauterine device
- Brachytherapy for carcinoma of cervix
Triad:Amenorrhea, cyclic hematuria without urinary incontinence in combination with a history of LSCS has been described as pathognomonic of VUF
- Cyclical hematuria
- Urinary continence (urinary incontinence occurs if the level of the VUF is at or below the internal os or if the os is incompetent)
Diagnosis is mainly established by clinical detection of urine or dye passing through the external cervical os or by means of a hysterosalpingogram or micturating cystourethrogram, which will demonstrate the fistulous communication.
- Double echogenic line between the uterus anterior wall and the posterior wall of the bladder
CystoscopyDetermination and localization of the presence of a fistula and the determination of its position with the trigone.
Hysterosalpingography (HSG):Gold standard investigation in demonstrating the fistulous track.
Treatment methods include expectant management with long-term bladder catheterization, medical treatment, and surgery.
Medical management:Involves induction of amenorrhea to aid in fistula healing
- Oral contraceptives
- Progestational agents
- Gonadotropin releasing hormone analogs
Surgical management:Definitive method of treatment. It can be performed transabdominally, endoscopically, and robotically.
- Transabdominal repair: Extraperitoneal or retrovesical (O’Connor) technique
- Laparoscopic approach