Surgical treatment of a vesico-uterine fistula after cesarean section

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Аннотация

Relevance: The article discusses the diagnosis and surgical treatment of a complex obstetric complication, namely vesico-uterine fistula after cesarean section (Youssef’s syndrome), with a minimally invasive access and modern medical technologies. Vesico-uterine fistula is usually a complication of surgical delivery or pathological delivery and it accounts for up to 9% of all urogynecological fistulas. The article presents the analysis of modern literature on genitourinary fistulas and a clinical observation of a vesico-uterine fistula in a 38-year-old patient.

Case report: The patient presented with hypomenorrhea and cyclic discharge of urine with blood during menstruation, periodic pain in the lower abdomen. In addition to standard visual diagnostic techniques, such as ultrasound and MRI, an office cystoscopy was performed to diagnose a fistula. The vesico-uterine fistula was sutured using laparoscopic access, with simultaneous metroplasty performed using fibrin glue. The long-term results of the operation were assessed after 4 months; the patient had no problems with urination; the thickness of the myometrium in the metroplasty area was 4 mm.

Conclusion: In order to prevent the development of a vesico-uterine fistula during cesarean section, it is necessary to perform the bladder mobilization. The vesico-uterine fistula should be sutured by a multidisciplinary surgical team with the participation of a urologist.

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Авторлар туралы

А. Kozachenko

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Хат алмасуға жауапты Автор.
Email: a_kozachenko@oparina4.ru
ORCID iD: 0000-0002-5573-6694

Dr. Med. Sci., Senior Researcher at the Gynecological Department

Ресей, Moscow

T. Shatylko

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: t_shatylko@oparina4.ru
ORCID iD: 0000-0002-3902-9236

PhD, urologist at the Andrology and Urology Department

Ресей, Moscow

A. Dzhabiev

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_dzhabiev@oparina4.ru
ORCID iD: 0000-0002-2858-0129

PhD, doctor at the Ultrasound and Functional Diagnostics Department

Ресей, Moscow

E. Latfullina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: latfullinaelina@mail.ru
ORCID iD: 0009-0004-6586-7788

resident physician

Ресей, Moscow

Әдебиет тізімі

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1. JATS XML
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2. Fig. 1. Ultrasound of the pelvic organs in 3D mode. A fistula tract is determined between the bladder and the uterine cavity with locally thickened mucous membrane

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3. Fig. 2. Ultrasound of the bladder. Thickening of the mucous membrane of the posterior wall of the bladder in the area of the fistula defect up to 6.6 mm is noted.

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4. Fig. 3. Ultrasound of the pelvic organs in 4D mode. A star-shaped fistula defect with retractions of the bladder mucosa into the fistula tract is determined.

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5. Fig. 4. MRI of the pelvic organs: the first image in the sagittal plane T2-weighted image shows retraction from the serous membrane in the area of the vesicouterine space, cicatricial changes; the second image in the coronal plane T2-weighted image shows a defect in the anterior wall of the uterus with retraction of the wall of the urinary bladder, more on the left

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