Successful Repair of Iatrogenic Cyclical Menouria

Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only (1-4%) of all genitourinary fistulas. It is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment caesarean section. Patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint. Among all vesicouterine fistula 90% are Youseef’s Syndrome the least common of the urogynaecological fistulas. Youseef’s syndrome is characterized by cyclic haematuria (menouria), absence of vaginal bleeding (amenorrhea) and urinary incontinence due to vesicouterine fistula (VUF).TAJ 2017; 30(1): 70-72

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Youssef’s syndrome following caesarean section: a rare case with review of literature

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184546 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4772

Author(s):

Vikas Devkare ◽

Meenakshi Gothwal ◽

Nandkishor Gaikwad ◽

Sushil Pawar ◽

Neha Agrawal ◽

...

Keyword(s):

Urinary Incontinence ◽

Caesarean Section ◽

Rare Case ◽

Negative Impact ◽

Rare Condition ◽

Review Of Literature ◽

Lower Segment ◽

Vesicouterine Fistula ◽

Lower Segment Caesarean Section

Youssef’s syndrome is a rare condition characterized by vesicouterine fistula with cyclic haematuria, amenorrhoea and incontinence of urine. A vesicouterine fistula is an abnormal connection between the uterus and bladder that most commonly occur due to inadvertent injury to the bladder during lower segment caesarean section. Vesicouterine fistula leads to psychological and has the negative impact on quality of life. A high suspicion should be kept in mind if the patient presents with urinary incontinence even many years after caesarean section. However, conservative management may be appropriate in some cases, but the definitive mode of management is surgery. Hereby authors present a 22-year-old para 2 live 2 (previous 2 caesarean section) with vesicouterine fistula with the complaint of urinary incontinence, cyclical haematuria (menouria) and amenorrhoea a year after caesarean section done due to obstructed labour.

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Youssef’s Syndrome following Cesarean Section

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/605325 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ozer Birge ◽

Ertugrul Gazi Ozbey ◽

Mustafa Melih Erkan ◽

Deniz Arslan ◽

Ilkan Kayar

Keyword(s):

Urinary Incontinence ◽

Cesarean Section ◽

Diagnostic Tests ◽

Vaginal Bleeding ◽

Clinical Presentation ◽

Definitive Treatment ◽

Lower Segment ◽

Vesicouterine Fistula ◽

Lower Segment Cesarean Section ◽

Variable Clinical Presentation

Youssef’s syndrome is characterized by cyclic hematuria (menouria), absence of vaginal bleeding (amenorrhea), and urinary incontinence due to vesicouterine fistula (VUF), the least common of the urogynecological fistulas. Youssef’s syndrome has a variable clinical presentation. A vesicouterine fistula is an abnormal pathway between the bladder and the uterus. The most common cause is lower segment Cesarean section. Conservative treatment may be appropriate in some cases, but surgery is the definitive treatment. Vesicouterine fistula should be suspected in cases presenting with urinary incontinence even years after Cesarean section. Diagnostic tests as well as necessary appropriate surgery should be performed on cases with suspected vesicouterine fistula. We present a 40-year-old multiparous woman with vesicouterine fistula after primary Cesarean section; she presented with urinary incontinence, hematuria, and amenorrhea 1 year after the birth. Here, we discuss our case with the help of previously published studies found in the literature.

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Delayed presentation of postcaesarean section vesicouterine fistula repaired robotically

BMJ Case Reports ◽

10.1136/bcr-2020-234902 ◽

2021 ◽

Vol 14 (1) ◽

pp. e234902

Author(s):

Edward Ramez Latif ◽

Mohammed Kamil Quaraishi ◽

Davon Mitchell ◽

Edward Streeter

Keyword(s):

Urinary Incontinence ◽

Caesarean Section ◽

Vaginal Bleeding ◽

Delayed Presentation ◽

Premenopausal Patient ◽

Robotic Assisted ◽

Vesicouterine Fistula ◽

Flexible Cystoscopy ◽

Symptomatic Anaemia ◽

History Of

A premenopausal patient in her late forties presented with a 15-year history of urinary incontinence starting shortly after a caesarean section performed for her fourth delivery and more recently associated episodic light haematuria and passage of clots per vagina. The haematuria was intermittent over several months and associated with per-vaginal bleeding. She had symptomatic anaemia. Flexible cystoscopy and MRI showed a vesicouterine fistula. She underwent a robotic-assisted hysterectomy and multi-layered repair of the bladder with omental interposition. She remained in the hospital for 4 days, though recovered well and underwent catheter removal at 14 days following a normal cystogram. At 3 months, she was well with no incontinence or urinary symptoms. This case demonstrates the need for vigilance in assessing patients with persistent incontinence, particularly in the context of prior caesarean section. It highlights the feasibility of robotic surgery for correcting these defects in a society where minimally invasive surgery is becoming the norm, and cosmesis is a priority for patients.

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