Vesicouterine fistula: A rare complication of vaginal birth after cesarean
Background
Vesicouterine fistula is rare. We report a vesicouterine fistula that was the direct result of a vaginal delivery in a patient with a history of lower uterine segment cesarean delivery.
Case
A woman developed a vesicouterine fistula during vaginal delivery after a previous cesarean. An anterior uterine wall defect was noted immediately after the delivery. Continuous bladder drainage was unsuccessful in managing her fistula, and surgical correction was necessary.
Conclusion
Although rare, a vesicouterine fistula can occur as a complication of vaginal delivery in patients with a history of cesarean delivery.
References (4)
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Vesicouterine fistula: A rare complication of caesarean section
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Vesicouterine fistulae as complications of repeated cesarean section
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Cited by (21)
Simultaneous Uterine and Bladder Rupture Following Successful Vaginal Birth After Cesarean Delivery: Laparoscopic Repair of Defect
2017, Journal of Minimally Invasive GynecologyWhen gross hematuria occurs after a successful vaginal birth after cesarean section, bladder injury should be suspected. We report a postpartum patient who experienced progressively worsening abdominal pain a few hours after delivery and was found to have a simultaneous bladder and uterine rupture, which were successfully repaired via a laparoscopic approach. This case highlights a laparoscopic approach to repairing both defects in the immediate postpartum period.
Simultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean Delivery
2010, Journal of the Chinese Medical AssociationUterine rupture is the primary concern when a patient chooses a trial of labor after a cesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross hematuria occurs. We report the case of a patient with uterine rupture during a trial of labor after cesarean delivery. She had a normal course of labor and no classic signs of uterine rupture. However, gross hematuria was noted after repair of the episiotomy. The patient began to complain of progressive abdominal pain, gross hematuria and oliguria. Cystoscopy revealed a direct communication between the bladder and the uterus. When opening the bladder peritoneum, rupture sites over the anterior uterus and posterior wall of the bladder were noted. Following primary repair of both wounds, a Foley catheter was left in place for 12 days. The patient had achieved a full recovery by the 2-year follow-up examination. Bladder injury and uterine rupture can occur at any time during labor. Gross hematuria immediately after delivery is the most common presentation. Cystoscopy is a good tool to identify the severity of bladder injury.
Risk factors for bladder injuries during cesarean section
2009, Actas Urologicas EspanolasIdentificar los factores de riesgo para lesión vesical durante la operación cesárea.
Se realizó un estudio de casos y controles de mujeres sometidas a cesárea en el periodo comprendido entre el 1 de enero de 2001 y el 31 de diciembre de 2007 en el INPerIER. Los casos fueron mujeres que habían sufrido lesión vesical en el procedimiento, como controles se seleccionaron al azar 2 mujeres por caso a las que se les realizó cesárea sin lesión vesical en el mismo periodo de tiempo. Se revisaron los expedientes analizando las características demográficas y clínicas las cuales se compararon entre sí.
Se encontraron 21 lesiones vesicales entre 24,057 cesáreas (incidencia 0,087%), de las cuales sólo se analizaron 19. La cesárea previa fue más frecuente en los casos que en los controles (63% vs 42% p 0,134), con un Odds Ratio (OR) de 2,35 (IC 95% 0,759- 7,319), al comparar el antecedente de una cesárea contra ninguna el OR resultó de 3,75 (IC 95% 1,002- 14,07). Se encontraron diferencias estadísticamente significativas (p<,05) en: edad gestacional (38,16 vs 37,35 semanas), una cesárea previa (42% vs 18%), adherencias (79% vs 5%), VBAC (31,5% vs 3%), incisión media (16% vs 68%), incisión Pfannenstiel (84% vs 32%), hemorragia (744cc vs 509cc) y tiempo quirúrgico (135 vs 58 minutos), con lesión vesical y sin ella respectivamente. No se encontraron diferencias significativas en la edad materna, el IMC, cirugías previas, TDP, RPM, altura del feto, corioamnioitis, preinducción, incisión uterina, urgencia del procedimiento o ruptura uterina. La presencia de adherencias tuvo un OR de 67,5 (IC 95% 11,14- 408).
El antecedente de cesárea y de adherencias son factores de riesgo para lesión vesical durante la cesárea.
To identify risk factors for bladder injury during cesarean delivery, to let patients and doctors know them and their importance.
We conducted a case-control study of women undergoing cesarean delivery at the Instituto Nacional de PerinatologíaIsidro Espinosa de los Reyes between january 2001 and december 2007. Cases were women with bladder injuries at the time of cesarean section. Two controls per case were selected randomly. Medical records were reviewed for clinical and demographic data to compare them.
Twenty-one bladder injuries were identified among 24, 057 cesarean sections, (incidence 0.087%), only 19 were analized. Prior cesarean section was more prevalent among cases than controls (63% vs 42% p 0.134), with an OR of 2.35 (95% CI 0.759- 7.319), when we take only patients with one cesarea in contrast with no cesarea the OR is 3.75 (95% CI 1.002- 14.07). Statistically significant differences (P values < .05) between cases and controls were found in gestacional age (38.16 vs 37.35 weeks), prior cesareans (42% vs 18%), adhesions (79% vs 5%), Odds ratio of 67.5 (95% CI 11.14- 408), VBAC (31.5 vs 3%), median skin incisión (16% vs 68%), Pfannenstiel (84% vs 32%), blood loss (744cc vs 509cc) and length of surgery 135 vs 58 minutes). No differences were found among age, BMI, prior surgery, labor, premature rupture of membranes, station, chorioamnioitis, induction, uterine incision, timing of delivery, uterine rupture.
Prior cesarean section and adhesions are risk factors for bladder injury at the time of repeat cesarean delivery. Elective cesarean delivery is valid but it is duty of physicians to inform patients the risks of it.
Diagnosis and treatment of fistulas
2006, Clinical GynecologyLower Urinary Tract Fistulas
2006, Urogynecology and Reconstructive Pelvic Surgery, Third EditionMinimizing the Urological and Psychological Morbidity of Urinary Tract Fistulae From VBAC
2006, Journal of Obstetrics and Gynaecology CanadaBecause of the relative rarity of the condition, there is no consensus for the timing of surgical repair of fistulae following vaginal birth after Caesarean section (VBAC).
Three cases f urinary tract fistulae following VBAC are presented. Two patients had an early repair (24–48 hours after delivery), and the third had a repair at four months after delivery. The surgical approach and intraoperative findings for the early and late repairs are described, and the psychological effects of early and late repair are compared. The early repairs were not technically difficult and were associated with less psychological morbidity.
In the absence of contraindications, early repair of urinary tract fistulae diagnosed within the first few days after VBAC delivery is preferred. If early repair is attempted, perioperative conditions must be optimized; urogynaecologic or urologic expertise and assistance should be considered.
En raison de la rareté relative de cette pathologie, il n’existe aucun consensus en ce qui a trait à la détermination du moment où l’on doit procéder à la réparation chirurgicale d’une fistule à la suite d’un accouchement vaginal après césarienne (AVAC).
Trois cas de fistule du tractus urinaire à la suite d’un AVAC sont présentés. Deux patientes ont bénéficié d’une réparation précoce (de 24 à 48 heures à la suite de l’accouchement), tandis que la troisième patiente n’a pu bénéficier d’une telle réparation que quatre mois à la suite de l’accouchement. L’approche chirurgicale et les constatations peropératoires associées aux réparations précoces et tardives sont décrites; de plus, les effets psychologiques de ces réparations sont comparés. Les réparations précoces ne se sont pas avérées difficiles sur le plan technique et ont été associées à une morbidité psychologique moindre.
En l’absence de contre-indications, il est préférable de procéder à la réparation précoce d’une fistule du tractus urinaire diagnostiquée dans les quelques premiers jours suivant un AVAC. Lorsqu’une réparation précoce est tentée, les conditions périopératoires doivent être optimisées; le recours au soutien de spécialistes en urogynécologie ou en urologie devrait être envisagé.