Youssef's syndrome, a rare complication of caesarean section: A case report

Youssef's syndrome or vesico-uterine fistula is an abnormal communication between the bladder and the uterus. It complicating of dystocic delivery, caesarean section and uterine rupture. The prevalence is globally 1-4 % of all obstetric fistulas. In Niger, it accounts for 6.4 % of iatrogenic urogenital fistulas. The best treatment is transvesical or transperitoneal surgery to close the bladder and uterus separately, with or without retaining the uterus.

We report a case of Youssef's syndrome secondary to caesarean section for uterine rupture in a 32-year-old woman. She consulted in our department for urinary incontinence occurred in the postoperative period. The diagnosis was made on clinical examination using the methylene blue test that is the only diagnosis method available in our setting. Treatment was initially medical with a bladder catheter until uterine involution (six weeks), followed by surgical cure using the Chassar-Moir technique.

Youssef's syndrome accounts 1-4 % in general population, 6.4 % in west Africa and 5,2 % in Niger. Various management were reported: Medical treatment, surgical treatment via transvesical, retroperitoneal and transperitoneal routes that remains the most indicated method and, cystoscopic fulguration and laparoscopic treatment that have recently been proposed.

This study reminds practitioners to be more vigilant in preventing this complication during any pelvic surgery by ensuring: careful release of vesico-uterine adhesions, bladder leakage test and careful repair of any bladder wounds followed by postoperative bladder drainage.