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Early detection and endoscopic management of post cesarean section ureterovaginal fistula: a case series study

Abstract

Introduction and hypothesis

The aim of this study was to evaluate the endourologic management of post-cesarean section ureterovaginal fistula.

Methods

Between February 2016 and March 2019, eight patients presented because of vaginal leakage after cesarean section. All presented within 15 days from their original operations. Three of the patients had a vague lower abdominal pain, and five had ipsilateral flank pain; all had vaginal leakage. Physical examination, ultrasonography, and IVP were done to confirm the diagnosis. Ureteroscopy was the first treatment attempt, using two or three guide wires to find the proximal part of the ureter and insert a JJ stent.

Results

In six patients, we could insert guide wires, find the proximal part of the ureter, and finally insert a JJ stent. In two patients, we could not even pass a guide wire, so we changed the position, and ureteral reimplantation was done. The stents were removed after 6 weeks, and after 3 months an IVP was planned again that showed all fistulae had resolved with no evidence of ureteral stricture.

Conclusion

In cases of ureterovaginal fistula after cesarean section, ultrasonography and IVP with lateral view x-ray films may confirm the diagnosis. The traditional treatment for ureterovaginal fistula is ureteral reimplantation, but endoscopic management may be a viable technique with less invasiveness and faster results and recovery. Thus, retrograde stenting can be accomplished in selected patients with ureterovaginal fistula after cesarean section and may eliminate the need for reimplantation of the ureter.

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Acknowledgments

We thank the director of Beheshti Teaching Hospital for providing easy availability to the medical records of the patients.

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Correspondence to Seyed Mohammadreza Rabani.

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Approved by the local committee of Yasuj University of Medical Sciences (IR.YUMS.REC.1399.020).

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Rabani, S.M., Rabani, S. Early detection and endoscopic management of post cesarean section ureterovaginal fistula: a case series study. Int Urogynecol J 32, 2537–2541 (2021). https://doi.org/10.1007/s00192-020-04589-7

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Keywords

  • Ureteroscoic surgical procedure
  • Cesarean section
  • Vaginal fistula