[Vesico-uterine fistulas. Report of 30 cases]

The authors report a series of 30 vesico-uterine fistulas (VUF) observed over a 25-year period. The mean age of the patients was 28 years (range: 18 to 40 years). VUF were secondary to caesarean section (23 cases), abnormal delivery (5 cases) and rupture of the bladder and uterus (2 cases). The presenting complaint was a permanent total and isolated urinary incontinence (22 cases), partial urinary incontinence associated with menstrual haematuria (4 cases), vesical menstrual bleeding associated with a oligomenorrhoea (3 cases) and menouria (1 case). The diagnosis was established on clinical findings in 14 patients. IVU, performed in 30 patients, visualized the uterine cavity in only 12 patients. Retrograde cystography, performed in 4 cases, demonstrated opacification of the uterine cavity. Hysterosalpingography, performed in 6 cases, confirmed the diagnosis of VUF in all 6 patients. Treatment was surgical, via a transperitoneovesical incision (22 cases) or a transvesical incision (8 cases) and consisted of isolation of the bladder and uterus and uterine and vesical suture. Urine drainage was performed by urethral catheter (28 cases) or cystostomy (2 cases). Urinary continence was perfectly restored in 24 patients, 6 patients presented residual fistulas another patient had a reduction of her bladder capacity. The objective of this study is to analyse the aetiological, diagnostic and therapeutic aspects of this disease.