[Uretero-uterine fistula after caesarian section. A report on one case (author's transl)]

The authors report a new case of uretero-uterine fistula and on this basis review the 9 other publications devoted to this subject since 1971. In their own case, the diagnosis was based upon the clinical picture only : permanent flow of urine through the uterine cervix with persistence of normal micturation and left lumbar pain following a caesarian section. Uretero-pyelo-calyceal distension proximal to a low pelvic ureteric stenosis visible by IVU was confirmed by RUP which succeeded in opacifying only the final 3 cm of the ureter. Only peroperative opacification of the ureter showed the fistula tract with the uterus. This was successfully treated by uretero-vesical reimplantation into a psoas bladder. Review of the literature revealed the following points : --The ureter is damaged by blind haemostasis of bleeding at the lateral angle of the hysterotomy, most often on the left, as a result of dextrorotation. --Clinical features consist of the urinary fistula, pain and infectious complications with upper urinary excretory tract obstruction. --The ureteric lesion is situated very low down, between 2 and 4 cm above the ureteric meatus. --Uretero-vesical reimplantation into a tubular vesical flap or a psoas bladder ensures treatment when the kidney remains functional. --The prevention of such lesions may be summarised very briefly : beware of the ureter at the lateral angles of hysterotomy for caesarian section.