Vesicouterine fistula--variable clinical presentation

Vesicouterine and vesicocervical fistula are mostly caused by trauma during lower segment caesarian section. The clinical presentation and management of nine cases are described. Presentation was typical, i.e. cyclic haematuria (menouria) without urinary leakage, in three of the nine patients, and atypical--vaginal leakage of urine, urethral passage of lochia and/or regular vaginal menes--in six patients. The diagnosis was made clinically, radiologically and endoscopically. Surgical repair was successfully performed in eight cases and one was managed conservatively with satisfactory outcome. Atypical presentation of such fistulas may considerably delay the diagnosis. In contrast to vesicovaginal fistula, conservative management may be tried in selected cases.