Vesicovaginal fistula vvf is a subtype of female urogenital fistula ugf. Cpt code information is available to subscribers and includes the cpt code number, short description. Vesicouterine fistula is a rare complication of gynecologic surgery, which is usually treated by abdominal hysterectomy and bladder repair. Vesicouterine fistula, a rare cause of genitourinary fistula. It can occur as a standalone fistula or can accompany a. Vesicouterine fistula presenting with urinary incontinence 30 years after primary cesarean. Vesicouterine fistula definition of vesicouterine fistula. Emergency lower segment cesarean section is the most common cause of vuf which accounts for 23 rd of the cases. Mar 01, 2016 vesicovaginal fistula vvf is a subtype of female urogenital fistula ugf. Hysterography may show leakage of contrast media into the bladder. 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. Vesicouterine fistula is an uncommon urogenital fistula. There are some reports of success with the conservative treatment.
The prevalence of obstetric fistulas has also fallen precipitously in the. We are reporting on a case in which the chronic fistula was caused by an iud having been placed 4 years ago. Pdf characteristics and repair outcome of patients with. 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 free and open source software to merge, split, rotate and extract pages from pdf files. The tunnel formation allows contaminants and waste products to leak where they are. It is seen more after repeat caesarean section rather than after the primary 1, 2. Vesicouterine fistulae are becoming more common because of the increase in the. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100%. In addition to the medical sequela from these fistulas, they often have a profound effect on the patients emotional wellbeing. Early versus delayed repair of vesicouterine fistula ncbi.
Pdf radiological diagnosis of vesicouterine fistula. Using excretory urography it is difficult to distinguish vesicovaginal fistula from vesicouterine fistula, because presence of contrast media in vagina is the only finding. 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 primary caesarean section bastakoti r1, saha r2. The obstetric vesicovaginal fistula in the developing world. Vesicouterine fistula is a rare iatrogenic urogenital fistula that communicates between urinary bladder and uterus or rarely cervix. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. Vesicovaginal fistulas are approximately three times more common than ureterovaginal fistulas, with ureterovesicovaginal fistulas being very infrequent. Congenital vesicovaginal fistula wiley online library. 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. 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. This tunnel is an anomaly, doctors do not know why the tunnel forms but they do know the results of this tunnel formation.
Implementation guide purpose of the manual to enable dedicated physicians to acquire the knowledge, skills and professionalism needed to. The fistula repair surgeries were uneventful and the patients had an unremarkable recovery. 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 is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder most commonly after an iatrogenic injury during caesarean section. 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. 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. Abdominal repair of vesicovaginal and vesicouterine fistula. We are reporting on a case in which the chronic fistula was caused by an iud having been placed 4. Marinsanchez p1, sanchezferrer ml2, garridonavarro c1. A fissure creates severe pain and is like a crack in the skin. Sexual assault has been linked to obstetric fistula, especially in conflict settings. 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. 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.
Ct scan with intravenous contrast media or ct with sagittal reformation after hysterography is also. The incidence is on the rise because of increasing incidence of cesarean sections. The objective of our report is to present three cases of vesicouterine fistulas. This is the third known report of vesicouterine fistula diagnosed during pregnancy. 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. Between january 2003 and january 2011, 12 patients with a diagnosis of vuf. After a thorough discussion of surgical approaches and informed consent, she elected to proceed with lapa roscopic repair. 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. They may be associated with endom etriosis 4 as in our fig. Current procedural terminology closure of vesicouterine. Anorectal fistulas are common among people who have an anorectal abscess, crohn disease, or tuberculosis.
Because the tract did not close spon taneously, the patient was offered surgery. Urethrovaginal fistula is a distinct type of fistula that has to be differentiated from vesico vaginal fistula. 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. The symptoms are menouria and urinary incontinence. Only 5% of the patients respond to conservative management, and the rest of them needs definitive surgical repair 1. Surgery is the treatment of choice in most cases, especially for large vesicouterine fistulas which invariably necessitate surgical closure. Early versus delayed repair of vesicouterine fistula. Treatment of vesicouterine fistula by fulguration sciencedirect. Surgical repair is the gold standard treatment for vvf and numerous closure. Treatment options of vesicouterine fistulas are vari ous. Characteristics and repair outcome of patients with vesicovaginal fistula managed in jimma university teaching hospital, ethiopia.
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. Lower urinary tract fistulas can communicate with the vagina or the uterus fig. This video nicely depicts the laparoscopic repair of a vesicouterine fistula. Laparoscopic treatment of vesicouterine fistula miklos bladder drainage for 4 weeks with a transurethral foley catheter. Uterovesical fistula free download as powerpoint presentation. All patients in the present study had history of lower segment cesarean section. Although the indications for abdominal repair of vesicovaginal fistula are somewhat controversial, certain conditions involving the. May 17, 2012 a retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. A vesicovaginal fistula is an abnormal connection between the bladder which stores urine and the vagina.
Vesicouterine fistula vuf is a rare type of fistula accounting for only 14% of all cases of urrogenital fistula. 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. 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. Laparoscopic repair for vesicouterine fistulae introduction. Conservative management of uterovesical fistula following. These are conservative, medical or surgical treat ments. Complications of fistula repair surgery sherif mourad. Vesicovaginal fistula vvf affects an estimated three million women internationally.
In particular, the epidemiology, aetiology, diagnosis, treatment and prevention of non obstetric fistula have been described in detail during the recent international. We present 3 cases of vesicouterine fistula with successful surgical repair in which 2 patients had an early repair. 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. Doctor answers on symptoms, diagnosis, treatment, and more. 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. Bladder wall is disrupted, with hypoechoic line arrow joining bladder and uterus. Vesicouterine fistula is a rare complication of cesarean section due to a transverse incision into the lower segment. The authors report 5 cases of uterovesical fistula uvf and analyse some of the clinical and therapeutic aspects of this disease. Excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. Obstetric fistula geneva foundation for medical education and. The vesicouterine fistulae vuf comprise 29% of all urogenital fistulae. Although the obstetric fistula was once common in western europe and the united states, it is virtually unknown in these regions today. All six obstetrical cases were related to cesarean section.
A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The symptoms are menouria and urinary incontinence excretory phase ct images show a fistulous tract between the uterus and bladder, indicating a vesicouterine fistula. A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome. 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. Cpt code information is available to subscribers and includes the cpt code number, short description, long description, guidelines and more. There is a welldefined defect in the lower anterior uterine body and posterior urinary bladder wall in the area of the prior cesarean section. Vesicouterine fistulae are uncommon and have been estimated to account for only 1% to 4% of all genitourinary fistulae. 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. Obstetrical fistulae womens health and education center. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks.
We present a survey of spontaneous migration of an 11week fetus from the uterine cavity into the urinary bladder through the longterm vesicouterine fistula. They include bladder decompression with an indwelling catheter and medical management to induce. However the incidence of vesicouterine fistula has been on the rise due to increasing incidence of lower segment caesarean section lscs. Vesicouterine fistulae resulted following cesarean. If uterovesical fistula was made immediately after. One patient who reported 3 months after the cesarean section was managed by estrogen and progesterone. Vesicovaginal fistulas can be congenital present at birth or acquired developing over time. During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. Longterm outcome of laparoscopic vesicouterine fistula. Vesicouterine fistula is an abnormal passageway between the cavities of the bladder and uterus. This is compatible with an acquired vesicouterine fistula. 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. Obstetrical fistulas johns hopkins bloomberg school of. In the treatment of uterovesical fistulas, conservative or surgical techniques have been used.
Vesicouterine fistula how is vesicouterine fistula. The type of urogenital fistula is based upon the anatomic location of the connecting tract. They discovered 14 such cases, and present the results of surgery. Conservative management of uterovesical fistula following primary caesarean section. 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. Youssefs syndrome has a variable clinical presentation. Combining it with reverse trendelenburg positioning enhances visualization with this technique. Scribd is the worlds largest social reading and publishing site. Understanding vesicocolic fistula symptoms starts with understanding exactly what a fistula is. 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. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. 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. Our patient was managed by laparoscopic transperitoneal fistula disconnection and closure.
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. In some cases of small fistula, no obvious tract may be noted. Vesicouterine fistula is a rare complication of caesarean delivery. The variety of problems encountered is enormous, which. A fistula going from the rectum to the scrotum would be life threatening. To retrospectively assess the value of magnetic resonance imaging mri in the diagnosis of vesicouterine fistula vuf.
Vesicouterine definition of vesicouterine by medical. 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. Vesicouterine fistula, a rare cause of genitourinary fistula ncbi. Followup cystogram after fulguration of fistula well in our hands.
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