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[A patient with a vesico-uterine fistula]
P L Venema1, H P Ottervanger, R J Tegelaar
1Afd. Urologie, Ziekenhuis Leyenburg, 's-Gravenhage.
Nederlands Tijdschrift Voor Geneeskunde
|March 12, 1994
Summary
A rare vesicouterine fistula in a uterus didelphys patient was diagnosed post-cesarean. Surgical repair involved a transperitoneal approach with peritoneal interposition, successfully treating this complex urinary tract abnormality.
Area of Science:
- Urology
- Gynecology
- Surgical Innovation
Background:
- Uterus didelphys is a rare congenital anomaly where the uterus and cervix are duplicated.
- Vesicouterine fistulas are uncommon, particularly presenting after cesarean delivery in patients with uterine anomalies.
- Accurate diagnosis is crucial, as symptoms can mimic more common vesicovaginal fistulas.
Observation:
- A 20-year-old woman with uterus didelphys presented with symptoms suggestive of a vesicovaginal fistula post-cesarean section.
- Initial vaginal examination and methylene-blue test were negative, complicating diagnosis.
- A vesicouterine fistula was suspected and subsequently visualized using a ureter catheter and radiopaque contrast instilled into the bladder.
Findings:
- Diagnosis of a vesicouterine fistula was confirmed in a patient with uterus didelphys.
- Radiographic visualization using contrast instillation proved effective in identifying the fistula's location.
- Surgical intervention was performed via a transperitoneal route.
Implications:
- This case highlights the importance of considering rare fistulas in complex gynecological and urological presentations.
- The transperitoneal surgical approach with peritoneal interposition offers a viable treatment strategy for vesicouterine fistulas.
- Improved diagnostic techniques and surgical management can lead to better outcomes for patients with congenital uterine anomalies and iatrogenic fistulas.