Vesicouterine fistula (VUF) is an iatrogenic consequence of cesarean section in the vast majority of cases. The global increase in cesarean delivery rates is accompanied by a rise in this complication.
The incidence of VUF is 0.6 to 6.5 cases per 1,000 births, with 33,500 new cases per year in Africa. VUF accounts for less than 5% of all fistulas and may be suspected in cases of hematuria or urinary incontinence after a cesarean section.
The diagnosis of vesicouterine fistula is based on the patient’s medical history, symptoms (especially incontinence), physical examination, and instrumental tests such as cystoscopy with dye. To assess ureteral injury, a CT scan with contrast medium in the delayed phase is used.

We begin the procedure by positioning the patient in the Lloyd-Davis position, using three 5 mm ports and one 10 mm port at the level of the umbilical scar.
Patient: 32-year-old woman, with no medical history. Postoperatively, after her second cesarean section, she reported vaginal urine leakage and urinary urgency with urge incontinence. CT images showed a contrast leak in the vesicouterine space, diagnostic of a fistula, with a collection in the Douglas pouch. The diagnosis was confirmed by cystoscopy. The patient was admitted six weeks after the cesarean section for surgical treatment of the fistula.
We begin the procedure by identifying the fistulous tract using rigid cystoscopy and placing a ureteral catheter with the aid of a guide in the fistulous tract.
Surgical Steps:
• Placement of vaginal valve.
• Dissection of the vesicouterine space.
• Identification of the fistulous tract.
• Opening and resection of the fistulous tract.
• Identification and sectioning of the omentum.
• Uterine closure using a 3/0 horizontal V-Loc suture.
• Omental interposition.
• Closure of the bladder tract with a continuous vertical 3/0 and 2/0 V-Loc suture.

• Operative time: 120 minutes.
• Hospital discharge: 48 hours post-surgery, with no postoperative complications. No drainage was placed.
• Bladder catheterization: Maintained for a total of 17 days.
• Follow-up cystography at 10 days: Mild contrast leakage observed, leading to the decision to keep the bladder catheter in place for an additional 7 days.
• After catheter removal: The patient remained continent.

Vesicouterine fistulas are a rare type of fistula. They may be suspected in cases of hematuria or urinary incontinence following a cesarean section. Conservative treatment is possible only in the absence of urinary incontinence. Surgery, whether open or laparoscopic, is the treatment of choice.Minimally invasive surgery improves visualization and outcomes. Surgical correction should include the interposition of the omentum between the uterus and bladder to reduce recurrence.