Surgically correcting a vesicouterine fistula with a myouterine flap. A case report.

Abstract

BACKGROUND The incidence of vesicouterine fistula has been increasing, most probably secondary to a corresponding increase in the use of low segment cesarean section. CASE A 37-year-old woman with a history of two cesarean sections, 14 years and 5 months earlier, presented with urge incontinence, cyclic hematuria and amenorrhea. Hysterosalpingography demonstrated contrast with the bladder and suggested a vesicouterine fistula. Following exploratory laparotomy and dissection of the bladder from the uterus, a fistula was seen connecting the anterior surface of the uterus and the posterosuperior aspect of the bladder. The fistula, with a cuff of uterus and bladder, was excised and the remaining defects repaired. In addition, a myouterine flap was raised to reinforce the repair. Upon follow-up the patient reported no difficulty in urination, complete urinary continence, normal menses and no hematuria. CONCLUSION This is the first case of vesicouterine fistula repaired with a myouterine flap. This technique strengthens the repair and is especially convenient due to its easy accessibility. A myouterine flap can be utilized if the omentum is of insufficient length or absent. The risk of postoperative bowel obstruction may be decreased as compared to omental interposition.

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@article{Char1997SurgicallyCA, title={Surgically correcting a vesicouterine fistula with a myouterine flap. A case report.}, author={D L Char and Svetlana Krasnokutsky and Zelik Frischer and Syed Mubashir Shah and J Bayshtok and Sher Ali Khan}, journal={The Journal of reproductive medicine}, year={1997}, volume={42 6}, pages={372-4} }