Vesicouterine fistula is an uncommon urogenital fistula. The incidence is on the rise because of increasing incidence of cesarean sections. Cyclical hematuria or menouria is an important clinical feature of this fistula which may or may not be associated with urinary incontinence depending on the location of the fistulous tract. We present a case report of vesicouterine fistula following 2 previous cesarean sections. This was successfully managed by cystoscopic fulguration followed by hormonal suppression of menstruation for 3 months. Vesicouteine fistula can be prevented if care is taken to separate the bladder from the uterus during repeat cesarean sections. Introduction Vesicouterine fistula (VUF) is a rare type of fistula accounting for only 1-4% of all cases of urrogenital fistula. However the incidence of vesicouterine fistula has been on the rise due to increasing incidence of lower segment caesarean section (LSCS). It is seen more after repeat caesarean section rather than after the primary 1,2 . There are other newer causes for these fistulas such as uterine artery embolisation 3 . Case Report Mrs. S. aged 24 years, a para 2 was admitted with history of haematuria during periods following her last caesarean section, performed 2 years earlier. Menouria or cyclical haematuria was her only complaint and she had no urinary incontinence. She had caesarean section for both the pregnancies in view of cephalopelvic disproportion. The post operative period following her last caesarean section had been uneventful. She noticed menouria when she resumed her cycles 10 months after the LSCS. Her menstrual flow through the genital tract was scanty. Her general and systemic examinations were normal. She had a midline vertical subumbilical caesarean scar. Pelvic examination revealed a normal sized anteverted uterus and fornices were free. Hysterography showed the flow of contrast from the uterus to the bladder, thereby confirming the presence of the fistula. Cystoscopy showed a fistulous opening in the bladder measuring around 7 mm in size (Fig 1). It was supratrigonal in position. Intravenous pyelography showed a normal upper renal tract. The bladder capacity was normal. The vesicouterine fistula was then treated by endoscopic fulguration after circumscribing the fistula. A parallel mucosal incision was made to allow the fistula to collapse. Continuous bladder drainage was maintained using a Foley's catheter for one week.She was then put on tablet Medroxyprogesterone continuously for 3 months to suppress menstruation. When the patient resumed her cycles four months later she did not have menouria and her menstrual flow was normal.
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