Vesicouterine fistula: teaching video on diagnosis and surgical treatment

Abstract

Introduction

A 42-year-old woman presented with urinary incontinence 9 years after the last of four vaginal deliveries. She had also had one Caesarean section. Immediately after the last delivery, she presented with haematuria, which resolved within a few hours, but the drain remained prophylactically for 7 days. Nine years later, she was referred to a specialist hospital.

Method

The patient presented with continuous urinary incontinence, and physical examination revealed a loss of urine from the vagina, the latter confirmed by a methylene blue test showing loss of urine from the uterine cervix. Other diagnostic techniques used were cystography, cystoscopy and uro-CT. Based on a literature review of the management options for such patients and the relevant clinical details of our patient, a decision was made to perform a total abdominal hysterectomy and fistula repair.

Results and discussion

Six months following surgery, the results were entirely satisfactory, with full urinary continence and significant improvement in the patient’s quality of life. A discussion about controversial approaches to diagnosis and management is included.