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Spontaneous closure of vesicouterine fistula. Account for effective hormonal treatment
1Department of Gynecology, Institute of Obstetrics and Gynecology, Bialystok Medical University, Bialystok, Poland. jozwikmc@obgyn.edu.pl
Objectives:
To analyze the incidence of spontaneous closure, or non-surgical resolution, of vesicouterine fistula and discuss the resultant implications for the management.
Methods:
Review of the literature supplemented by case report of a young woman with spontaneous healing of vesicouterine fistula.
Results:
This is the 41st patient with spontaneous closure of vesicouterine fistula reported to date. Her clinical course was suggestive of endocrine involvement in the lesion's formation. Spontaneous healing was observed in 5% of 796 vesicouterine fistula cases. Induction of amenorrhea was effective in 8 (89%) of the 9 patients treated, a rate significantly higher (p < 0.001) than that observed without hormonal manipulation (4%).
Conclusions:
Conservative management by means of hormonal treatment should be considered before surgical repair. We suggest the role of estrogens and the endometrium in the formation of vesicouterine fistulas.