Two Cases of Vesicouterine Fistula after Delivery in Women with Previous Cesarean Section.

Kim, Suk Bae; Youn, Young Eun; Park, Mi Sun; Park, Ok Rang; Kim, Hang Jin

Case Report

Korean Journal of Obstetrics & Gynecology 2006;49(9):1956-1961.
Published online September 1, 2006.

Two Cases of Vesicouterine Fistula after Delivery in Women with Previous Cesarean Section.

Suk Bae Kim, Young Eun Youn, Mi Sun Park, Ok Rang Park, Hang Jin Kim

Department of Obstetrics and Gynecology, Daegu Fatima Hospital, Daegu, Korea. obgybbl@hanafos.com

Abstract

Vesicouterine fistula, a fistula between bladder and uterus, is one of the rarest urogenital fistula. Most cases are associated with repeat Cesarean section and with vaginal birth after Cesarean section (VBAC). During Cesarean section, it is important to dissect and move the bladder away from uterus carefully, especially in case of adherent bladder to the anterior vaginal wall or lower segment wall and it is necessary to explain the possibility of vesicouterine fistula development in case of VBAC. Patients usually present with urinary incontinence in the early postoperative period or present months or years later with cyclic hematuria, amenorrhea, vaginal leakage of urine, urinary tract infection and secondary infertility. The diagnosis is made by cystoscopic visualization of the fistula orifice in the bladder and outlining the fistula tract on cystogram, hysterosalpingogram or transvaginal ultrasonogram. There have been varied approaches to the treatment of vesicouterine fistula with conservative therapy or surgical therapy. We experienced two cases of vesicouterine fistulas in women with previous Cesarean section, the one is delivered with repeat Cesarean section after trying VBAC, the other is delivered with vacuum assisted VBAC, and treated with surgical repair.

Key Words: Vesicouterine fistula, Previous Cesarean section, VBAC