Vesicouterine fistula: teaching video on diagnosis and surgical treatment

A 42-year-old woman presented with urinary incontinence 9 years after the last of four vaginal deliveries. She had also had one Caesarean section. Immediately after the last delivery, she presented with haematuria, which resolved within a few hours, but the drain remained prophylactically for 7 days. Nine years later, she was referred to a specialist hospital.

The patient presented with continuous urinary incontinence, and physical examination revealed a loss of urine from the vagina, the latter confirmed by a methylene blue test showing loss of urine from the uterine cervix. Other diagnostic techniques used were cystography, cystoscopy and uro-CT. Based on a literature review of the management options for such patients and the relevant clinical details of our patient, a decision was made to perform a total abdominal hysterectomy and fistula repair.

Six months following surgery, the results were entirely satisfactory, with full urinary continence and significant improvement in the patient's quality of life. A discussion about controversial approaches to diagnosis and management is included.