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OBJECTIVE

OBJECTIVE To highlight the importance of early detection of vesicouterine fistula (VUF) as this plays a key role in its spontaneous closure. CASE REPORT Clinical presentation . 23yr old G2P1 at 33 wks pregnancy underwent emergency repeat LSCS for scar tenderness.

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OBJECTIVE

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  1. OBJECTIVE To highlight the importance of early detection of vesicouterine fistula (VUF) as this plays a key role in its spontaneous closure. CASE REPORT Clinical presentation. 23yr old G2P1 at 33 wks pregnancy underwent emergency repeat LSCS for scar tenderness. Intra-operatively dense adhesions between bladder and lower uterine segment were released. Foley catheter was removed on 4th post operative day(POD). She was referred on 6th POD with complaints of intermittent gush of watery fluid per vaginum.. Her examination was unremarkable.No urinary incontinence demonstrated.Watery blood stained fluid was noted in vagina. Investigations and management. Contrast CT showed an irregular fistula tract between posterosuperior bladder wall and LSCS scar site suggestive of vesicouterine fistula. On Cystoscopy a 2.5 cm opening was seen in the posterior bladder wall supratrigonal area communicating with the uterus. Bladder was catheterized with Foley catheter 22fr for a duration of 3 wks At review, cystogram&CT pelvis did not demonstrate any fistula between bladder and uterus. Foley catheter was removed. Patient had no voiding difficulties.and is asymptomatic for the past one year. . VESICOUTERINE FISTULA - ROLE OF EARLY DETECTION IN SPONTANEOUS CLOSUREDr.Pallavi P, Dr.Sivakamasundari S, Dr.Padma S.Meenakshi Mission Hospital and Research CentreMadurai,Tamilnadu, India. • DISCUSSION • VUF are rarest of all genital tract fistulas. Most cases occur following LSCS(1)(2). • Inadvertent bladder injury can occur especially in repeat LSCS when bladder is densely adherent and is not adequately mobilized downwards from the lower uterine segment. • Mainstay of treatment is surgical and only 5% of cases resolve spontaneously. Spontaneous closure is maximum when diagnosis is made early in the post operative period before fibrosis of the fistula tract which takes 6 weeks. • Early detection plays a key role in the success of conservative Mx. • Conservative management includes bladder catheterization for 4-8 weeks, hormonal treatment for inducing amennorhoea and cystoscopic fulguration. If these options fail definitive management is surgical. • CONCLUSION • With increasing incidence of Caesarean section the incidence of • VUF is on the rise. • Patients usually present early in post operative period. High index of suspicion and prompt evaluation help to clinch the diagnosis. • 3) Conservative management is successful in cases detected early and avoids surgery and its associated morbidity. REFERENCES 1) Tancer ML.Vesicouterine fistula:a review. Obstet-Gynecol Surv 1986;41:743- 7532) Hodonou R,Hounnasso PP,Biaou O,Akpo C.Vesicouterine Fistula:report on 15 cases at Contonou University Urology Clinic.Prog Urol 2002;12:641-645 Vesicouterine fistula Post treatment

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