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10.5005/jp-journals-10033-1258
A Rare Case of Nocturnal Urinary Incontinence and Menouria after Lower Segment Cesarean Section
CASE REPORT

A Rare Case of Nocturnal Urinary Incontinence and

Menouria after Lower Segment Cesarean Section

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1 Deepti Shrivastava, SB Bhute, S Jajoo, Priyakshi Chaudhry
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ABSTRACT CASE REPORT
Misgav Ladach technique for lower segment cesarean section A 23 years old, P1L1, was admitted with chronic pelvic
(LSCS) is considered advantageous universally but debate pain, nocturnal bed wetting and cyclic hematuria during
still continues about nonclosure in layers and further conse-
quences, hence careful selection of cases and intraoperative periods following her last cesarean section, performed
decision of closure in layers is important if needed. The classical 2 years earlier in view of prolonged second stage of labor.
Youssef syndrome comprises of cyclic hematuria, amenorrhea, In day time she had frequency of urine but denied of
menouria, and complete urinary continence in a patient who any kind of incontinence. She was kept catheterized for
had LSCS. Here by, we are presenting a case report of woman 45 days postoperatively due to hematuria at the time of
suffered with chronic pelvic pain, menouria, nocturnal enuresis
after her LSCS done for obstructed labor, although not exactly LSCS. She noticed menouria too, when she resumed her
same as Youssef syndrome but rare in occerence and relieved cycles after the LSCS. Her menstrual flow through the
after adhesiolysis and gonadotropin release hormone (GnRH) genital tract was average in volume.
analog therapy. Her general and systemic examination findings
Keywords: Menouria, Nocturnal enuresis, Obstructed labor. were normal. She had a transverse cesarean scar. Pelvic
How to cite this article: Shrivastava D, Bhute SB, Jajoo S, examination revealed a normal sized anteverted uterus
Chaudhry P. A Rare Case of Nocturnal Urinary Incontinence with restricted mobility and induration felt through
and Menouria after Lower Segment Cesarean Section. World J fornices. Ultrasonography (USG) revealed normal size
Lap Surg 2015;8(3):107-109. uterus and normal urinary bladder and adnexae. Diag-
Source of support: Nil nostic hysterolaparoscopy with cystoscopy was planned.
Conflict of interest: None On cystoscopy, a small depression in posterior bladder
wall was seen covered with clots, methylene blue was
INTRODUCTION instilled through cervix to see any spillage from blad-

Lower segment cesarean section (LSCS) by Misgav Ladach der wall but it was negative. From suspicious tissue,
technique is the most frequently performed surgery by biopsy was sent for histopathological examination. On
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obs tetricians today. Incidences of postoperative adhesions laparoscopy anterior surface of uterus was seen com-
formation and urinary bladder endometriosis depend on pletely adherent to anterior abdominal wall and only
indivisual immune response of patient and to a some upper surface of uterus was visualized surrounded by
extent on skill of operator and careful selection of patients. adhesions all over (Fig. 1).
Recently peritoneal closure in two layers is documented To rule out any vesicouterine fistula and dissecting
by some studies to have lesser adhesion formation. 2,3 uterus, urinary bladder from anterior abdominal wall
Due to its fast and minimalist approach, it has been to make them free, laparotomy was done in same sit-
adopted by obstetricians worldwide but sometimes dense ting. On laparotomy, after some adhesiolysis uterus was
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adhesions are presented as a complication afterward. appeared sitting over the urinary bladder and densely
We are reporting one such case of overflow incontinence fixed to anterior abdominal wall (Fig. 2). Even after
and menouria due to dense adhesions and bladder wall complete separation of uterus and urinary bladder no
endometriosis following primary LSCS. fistulous track was observed in between, may be there
was initial injury during primary LSCS which was healed
up lea ving behind some endometrial tissue in the bladder
wall. Omental pad was kept in between uterus and
1 Professor and Head, Professor, Resident
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1-4 Department of Obstetrics Gynecology, Jawaharlal Nehru urinary bladder. Postoperative period was uneventful.
Medical College and Acharya Vinoba Bhave Rural Hospital Biopsy from urinary bladder confirmed endometrial
DMIMS, Wardha, Maharashtra, India glands. She was discharged on injection Leuprolide 1.25
Corresponding Author: Deepti Shrivastava, Professor and mg for 3 months.
Head, Jawaharlal Nehru Medical College and Acharya Vinoba Her urinary incontinence was totally resolved and
Bhave Rural Hospital, DMIMS, Wardha, Maharashtra, India when the patient resumed her cycles there was no
e-mail: deepti_shrivastava69@yahoo.com
menouria.
World Journal of Laparoscopic Surgery, September-December 2015;8(3):107-109 107