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Nidhi Mehta et al. 10.5005/jp-journals-10033-1344
case report

Vesicouterine Fistula Laparascopic Repair: A Case Report

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1 Nidhi Mehta, CP Dadhich, Tripti Dadhich, Anita Kumari
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ABSTRACT

Vesicouterine fistula (VUF) is a rare variety of female genito- CASE PRESENTATION
urinary fistula. It comprises 1–4% of all urogenital fistulas.
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Most of these fistulas are due to complications of the lower A 31-year-old P2L female presented to gynae outpa-
segment cesarean section (LSCS). The incidence of this fistula tient department (OPD) with complaints of passing of
is increasing all over the world because of the increasing preva- blood in urine since last 20 days and watery discharge
lence of cesarean section. Patients may present with urinary per vaginum since then. She gave a history of cesarean
incontinence, hematuria, cyclic menouria, amenorrhea and also
first trimester abortions. Two early diagnosis and repair of VUF section done at a district hospital in v/o non-progress of
has become the need of the hour. Different approaches for sur- labor with h/o excessive bleeding during surgery. The
gical repair of VUF include transabdominal (including transvesi- patient was managed with uterotonics and blood trans-
cal and transperitoneal); transvaginal approach; laparoscopic fusions. She had had a history of one previous normal
and robotic. Laparoscopic VUF repair results in reduced patient vaginal delivery 8 years back. Since the last 20 days, she
morbidity and shorter hospital stay without compromising the
results. So laparoscopic repair may be a more attractive treat- gave a history of hematuria and fever for which she was
ment option for patients with postcesarean VUF. catheterized at a private hospital and also managed on
iv antibiotics was then referred to the higher center for
Keywords: Cyclic menouria, Laparoscopic approach, Vesi-
couterine fistula. management. USG and Contrast MRI was done at our
center which showed 1.7 cm vesicouterine fistula in the
How to cite this article: Mehta N, Dadhich CP, Dadhich T, lower uterine segment with a urinary bladder full of
Kumari A. Vesicouterine Fistula Laparascopic Repair: A Case blood clots (Figs 1 and 2).
Report. World J Lap Surg 2018;11(2):106-109.
The patient was counseled and admitted for surgical
Source of support: Nil repair. The decision for surgery was taken as the patient
Conflict of interest: None had persistent fever and hematuria. All relevant and
necessary investigations and pre-anesthetic workup

Introduction done. Under combined anesthesia, the fistulous tract was
identified via cystoscopy, and the ureteric catheter was
Vesicouterine fistula (VUF), an abnormal communication passed from the bladder into the uterine cavity coming
between bladder and uterus; is a rare variety of urogenital out through cervix. Cystoscopy showed that the fistula
fistula. It occurs mostly due to iatrogenic causes, most was supratrigonal. Laparoscope introduced with two
common being cesarean section done in cases of obstructed accessory ports. Adhesiolysis and cystotomy done (Figs
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labor. Excessive bleeding during cesarean section or inad- 3 and 4).
equate bladder dissection may also add on to the etiology Placental tissues and membranes were found in the
of vesicouterine fistula being formed. The incidence of bladder (Fig. 5). Bladder repair was done in 2 layers. Also,
vesicouterine fistula being 1–4% is currently on the rise the uterine defect was repaired in layers. The integrity of
due to the rise in cesarean section rates worldwide. Patients bladder repair was checked with the filling of the bladder
may present with urinary incontinence, hematuria, cyclic with 200 mL of normal saline mixed with methylene blue
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menouria, amenorrhea and also first trimester abortions. (Figs 6 and 7).
Early diagnosis and repair of VUF has become the need Post-op period was uneventful. The patient was dis-
of the hour. charged with a catheter-in-situ. The patient was followed
up after a month when her catheter was removed and
ultrasound done again which showed no rent.
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1,4 Clinical Associate, HOD and Director, Senior Consultant
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DISCUSSION
1-4 Department of Obstetrics and Gynaecology, Eternal Heart
Care Center Hospital, Jaipur, Rajasthan, India A VUF is a rare variety of urogynaecological fistula and
Corresponding Author: Nidhi Mehta, Clinical Associate, a rare complication of second stage LSCS or cesarean
Department of Obstetrics and Gynaecology, Eternal Heart increased blood loss or inappropriate bladder dissection.
Care Center Hospital, Jaipur, Rajasthan, India, e-mail: According to history, the first case of VUF was reported
drnidhimehta83@rediffmail.com
in 1908. Patients of VUF may present with urinary
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