Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction
In developing countries traumatism of childbirth or deficient perinatal care still accounts for most fistulas. In contrast, in modern countries, modern obstetric care has greatly limited the risk of genitourinary fistulas.
Vesico-uterine fistula (VUF) is the rarest form of genitourinary fistulas, being in most cases secondary to previous cesarean section. It was first described in the literature by Burkland in 1949 but is known as Youssef's syndrome since its publication in 1957. Amenorrhea and menstrual bladder hemorrhage or menuria are the most common symptoms.
Surgical treatment consists of, classically, a transperitoneal approach with interposition of material. Despite the advantages of laparoscopy, there are few cases which report its feasibility in the management of this entity. Our aim is to review the management of a VUF (Youssef's syndrome) with a laparoscopic aproach.
We present a video with the surgical techniques involved in laparoscopic repair of VUF using primary closure of the fistula and TachoSil® interposition.
A 40-year-old woman was referred to our department with urinary incontinence associated to menuria, 2 months following an abortion at 22 weeks. The woman, otherwise healthy, had previously had 6 pregnancies and her first child was born by caesarean section. After birth of the 4th child, she presented vesico-vaginal fistula that was managed with a bladder catheter satisfactorily. The cystoscopy confirmed the findings of a well-granulated fistulous and the computerized axial tomography (CAT) showed the presence of VUF that connected the base of the bladder and the anterior uterine wall.
She underwent a laparoscopic repair of VUF with no complications in the surgical and postoperative period. She has remained asymptomatic with resumption of normal menses and no clinical evidence of fistula recurrence at 3 months follow-up.
Laparoscopic repair of a VUF is an effective and safe technique with successful outcome.