Case Report: Vesicouterine fistula following vaginal delivery

Document Type : Case report

Authors

1 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Assistant professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Various maternal obstetrical complications may occur following each type of delivery. One of these rare but important and problematic complications is orogenital fistula. The incidence of different types of orogenital fistula following delivery is more common in cesarean section and only few cases have been reported following normal vaginal delivery. In this article, a case of vesicouterine fistula after normal vagina delivery is reported.
Case presentation: The patient was a 31-year-old woman with third pregnancy and history of two previous normal vaginal deliveries without complication who had referred to the emergency ward of Mashhad Imam Reza hospital because of labor pain at gestational age of 38 weeks. Delivery progressed from the initial dilation 5 cm and effacement 60% within 2 hours of admission by spontaneous contractions. After delivery of head and shoulders, dystocia occurred during expulsion of abdomen due to large palpable abdominal mass in the fetus; and delivery was done with difficultly. Approximately 10 days after delivery, the patient referred with complaint of malodor watery discharge from vagina. After performing the methylene blue test, diagnosis of the vesicouterine fistula was confirmed by cystography. Urinary foley catheterization was inserted for the patient for 3 months and after re-performing cystography, vesicouterine fistula was completely repaired without need to surgery.
Conclusion: Vesicouterine fistula is of the rarest types of urogenital fistula which is often occurred following cesarean section and sometimes after normal vaginal delivery. One of the risk factors of vesicouterine fistula following vaginal delivery is “labor dystocia”. Many cases of vesicouterine fistula are treated by conservative management and surgery is not needed.

Keywords

References

  1. Machado Junior RA, Machado Junior LC, Lourenço LL. Vesicouterine fistula (youssef syndrome): case report and literature review. Rev Bras Ginecol Obstet 2018; 40(9):563-9.
  2. Yip SK, Leung TY. Vesicouterine fistula: an updated review. Int Urogynecol J 1998; 9(5):525-6.
  3. Symeonidis N, Sdralis E, Symeonidis A, Georgiadis C, Kalyvas V, Malioris A, et al. Vesicouterine Fistula (VUF) as a rare urogenital complication managed with delayed surgical repair: a case report and review of the literature. Case Rep Obstet Gynecol 2018; 2018:2394896.
  4. Bettez M, Breault G, Carr L, Tu Le M. Early versus delayed repair of vesicouterine fistula. Can Urol Assoc J 2011; 5(4):E52-5.
  5. Milani R, Cola A, Frigerio M, Manodoro S. Repair of a vesicouterine fistula following cesarean section. Int Urogynecol J 2018; 29(2):309-11.
  6. Talla P, Ekotomati M, Brünisholz Y, Bouquet de la Jolinière J, Fagan B, Feki A, et al. Consider the risk of vesicouterine fistula in the event of intermittent fluid vaginal discharge after a cesarean section. Front Surg 2017; 4:58.
  7. Alkatib M, Franco AV, Fynes MM. Vesicouterine fistula following cesarean delivery--ultrasound diagnosis and surgical management. Ultrasound Obstet Gynecol 2005; 26(2):183-5.
  8. Jozwik M, Jozwik M. Clinical classification of vesicouterine fistula. Int J Gynecol Obstet 2000; 70(3):353-7.
  9. Novi JM, Rose M, Shaunik A, Ramchandani P, Morgan MA. Conservative management of vesicouterine fistula after uterine rupture. Int Urogynecol J 2004; 15(6):434-5.
  10. Porcaro AB, Zicari M, Zecchini Antoniolli S, Pianon R, Monaco C, Migliorini F, et al. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Int Urol Nephrol 2002; 34(3):335-44.
  11. DiMarco CS, DiMarco D, Klingele CJ, Gebhart JB. Vesicouterine fistula: a review of eight cases. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17(4):395-9.
  12. Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 1992; 175(6):501-6.
  13. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38(8):1091-110.
  14. Abou‐El‐Ghar ME, El-Assmy AA, Refaie HF, ElDiasty TA. Radiological diagnosis of vesicouterine fistula: role of magnetic resonance imaging. J Magn Reson Imaging 2012; 36(2):438-42.
  15. Garely AD, Mann W. Urogenital tract fistulas in women. Waltham, MA: UpToDate; 2014.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 8
October 2019
Pages 85-90

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