Introduction: Vesico-cervical fistula is rare complications of gynecological procedures, often presenting with urinary incontinence. Most common reported cases were following cesarean sections or cervical cerclage application.

Case Presentation: A 45 year old, para 5 woman presented to our clinic with a 7 years history of persistent urinary incontinence initially misdiagnosed as urge incontinence and recurrent urinary tract infections leading to treatment with anticholinergics and antibiotics without improvement. Symptoms developed following dilation and curettage for retained placenta in normal vaginal delivery. She had 5 normal vaginal deliveries with average sized baby.  No other significant gynaecological or medical history was elicited. Clinical examination with methylene blue confirmed urine leakage through the anterior cervical lip. Comprehensive evaluation, including cystoscopy and imaging, revealed a vesico-cervical fistula 2 cm in size, located in the posterior bladder wall about 1.5 cm from the left ureteric orifice . Collaboration between urogynecologiests, urologists and radiologists to ensure precise diagnosis, surgical planning, and optimal outcomes.

Management: The patient underwent successful transabdominal surgical repair of the vesico-cervical fistula with an omental flap interposition to reinforce the closure and promote healing. Intraoperative confirmation of intact ureteral integrity, and uneventful post operative coarse. 
At 21-days follow up: no persistent urinary incontinence or leakage. Voiding Cystourethrography confirmed bladder integrity, then foley catheter successfully removed. 
At 6-month follow-up: patient was satisfied with the outcome. reporting no urinary incontinence, leakage, or recurrent infections. She resumed normal daily activities without limitations. Clinical examination confirmed successful surgical repair with no signs of fistula recurrence or bladder dysfunction.

Discussion: Vesico-cervical and vesico-uterine fistulas are unusual. A review of the literature from PubMed and Google Scholar from 1 January 1984 to 31 December 2023 revealed 18 different cases of vesicocervical fistulas caused by a traumatic caesarean section, cervical cerclage placement, high vaginal forceps delivery, curettage or manual removal of the placenta, placenta percreta, myomectomy, uterine rupture due to obstructed labour, perforation of an intrauterine device, and brachytherapy for carcinoma of cervix. Most of them were successfully managed surgically through abdominal repair. Obstetric outcome has been reported to be successful in many women who have attempted another pregnancy.

Conclusion: This case underscores the importance of considering fistulous tracts in patients with refractory incontinence post-gynecological procedures. A multidisciplinary team approach is crucial in managing vesico-cervical fistula. Surgical intervention via an abdominal approach resulted in complete symptom resolution, highlighting the value of tailored anatomical repair.

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