Vesicouterine fistula (Youssef syndrome): case report and literature review / Fístula vesico-uterina (síndrome de Youssef): descrição de caso e revisão da literatura

Abstract Objective To describe a case of vesicouterine fistula and to review the literature related to this condition. Methods For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed. Results A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment. Conclusion Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.

Resumo Objetivo Apresentar um caso de fístula vesico-uterina e realizar revisão da literatura sobre esta condição. Métodos Revisão realizada consultando-se as bases MEDLINE, BIREME e LILACS, além das referências dos artigos consultados. Resultados Uma mulher de 38 anos, após sua terceira cesárea, no puerpério imediato, apresentou hematúria importante, que foi atribuída a uma dificuldade na dissecção da bexiga durante o procedimento. Seis meses pós-parto, emvez de retomar os ciclos menstruais regulares, apresentou menúria cíclica e amenorreia (síndrome de Youssef). A paciente chegou a apresentar obstrução uretral por coágulos, e permaneceu sem diagnóstico correto até cerca de anos pós-parto, quando este foi feito por cistoscopia. Ela foi então submetida a correção cirúrgica por via abdominal, associada a uma histerectomia, com desaparecimento dos sintomas. A revisão mostrou que tem havido mudança na frequência dos vários tipos de fístulas urogenitais. As fístulas vesicovaginais, normalmente secundárias à má assistência durante o parto, têm sido mais raras, enquanto aquelas secundárias a procedimentos médicos, como as vesicouterinas, têm sido mais frequentes. A causa mais comum deste tipo de fístula é a cesárea, especialmente a de repetição. A apresentação pode ser de amenorreia e menúria e/ou perda urinária. O diagnóstico é feito por um ou maismétodos de imagem ou cistoscopia. O tratamento mais comum é cirúrgico, por via abdominal aberta, laparoscópica, transvaginal ou robótica. Existem relatos de cura com tratamento conservador. Conclusão As fístulas vesicouterinas têm sido mais comuns devido ao aumento da proporção de cesáreas. Deve-se ter em mente a possibilidade deste diagnóstico e considerá-las uma das possíveis complicações da cesárea.

Magnetic resonance imaging to detect vesico-symphyseal fistula following robotic prostatectomy

Pubic complications following radical prostatectomy are rare. Osteitis pubis typically presents with symptoms related to irritation of the pubic rami including pain with ambulation and adduction of the leg. A 60-year-old male with prostatic adenocarcinoma underwent uneventful robotic assisted laparoscopic prostatectomy. The patient noted the onset of severe pubic pain exacerbated by ambulation approximately one month post-surgery. An abdominal/pelvic CT scan was negative for acute pathology. Due to continued discomfort, a multiplanar MRI of the pelvis was performed with and without intravenous contrast material (20 ml Omniscan). The MRI demonstrated irregularity of the bladder base and proximal urethra with a fistulous tract extending anteriorly in direct communication with the pubic symphysis joint space. Vague periarticular marrow edema-like signal and enhancement at the pubic symphysis was thought to represent osteitis pubis. The patient's symptoms resolved after one month of urethral catheter drainage, intravenous antibiotics, and anti-inflammatory therapy.

Fístulas colovesicales: análisis de 7 casos / Colovesical fistula: report of 7 cases

Introducción: La fístula colovesical es una comunicación anormal entre vejiga e intestino grueso. Generalmente es secundaria a una enfermedad inflamatoria o neoplásica representando un desafío tanto diagnóstico como terapéutico. Material y método: Se revisaron en forma retrospectiva los pacientes intervenidos con el diagnóstico de fístula colovesical entre agosto de 1991 y mayo de 2006, registrando su distribución por sexo, edad, etiología, sintomatología, exámenes complementarios y tratamiento quirúrgico. Todos los pacientes se estudiaron mediante tomografía axial computada (TAC), cistoscopia y enema baritado. Resultados: Se revisaron 7 pacientes, hombre/mujer 4/3, con edad promedio de 60 años (rango 42-82). En 5 pacientes (71,5 por ciento) la fístula fue secundaria a una enfermedad diverticular complicada y en 2 casos (28,5 por ciento) a neoplasia de colon. La fecaluria y la neumaturia fueron los principales motivos de consulta. En 2 casos (28,5 por ciento) el motivo de consulta fue dolor pélvico, y 2 pacientes (28,5 por ciento) consultaron por infecciones urinarias. La cistoscopia mostró el orificio fistuloso en 4 de 7 pacientes (57,1 por ciento). El enema baritado mostró la fístula en 4 de7 casos (57,1 por ciento). La TAC fue diagnosticada en 5 de 7 casos(71,4 por ciento). En los 7 casos se efectuó una hemicolectomía izquierda más cistectomía parcial. El promedio de días de hospitalización fue de 9,7 días (rango 7-12) y no se registraron complicaciones posoperatorias ni mortalidad. Conclusiones: La fístula colovesical es una patología poco frecuente. Su principal etiología es la enfermedad diverticular complicada. Fecaluria y neumaturia son signos patognomónicos. La TAC es el examen diagnóstico de elección. El tratamiento es quirúrgico, y en la actualidad se recomienda la reparación en un tiempo operatorio.

Introduction: Colovesical fistula is an abnormal comunication between the bladder and the colon. Usually it is associated with inflammatory or neoplasic disease and its management remains a challenge Material and methods: Patients with colovesical fistula that underwent repair between 1991 and 2006 were analyzed. Age, sex, etiology, clinical and imaging findings were reviewed. All patients underwent CT scan with rectal contrast. Results: Out of 7 patients (4 male) with a mean age of 60 years (range 42-82), fistula was secondary to complicated colonic diverticula and colonic tumour in 5 (71.5 percent) and 2 (28.5 percent) respectively. Fecaluria and pneumaturia were the main complains. Two patients were seen for pelvis pain and another two for urinary infections. Cystoscopy allowed for fistula identification in 4 out of 7 patients (57.1 percent). Retrograde colonography was positive in 4 out of 7 cases. CT scan showed fistula in 5 of the 7 patients (71.4 percent). All patients underwent left colectomy and partial cystectomy. Mean hospital stay was 9.7 days (range 7 to 12) there were no postoperatory complications. Conclusion: Colovesical fistula is a rare occurrence. Its main etiology is colonic diverticular disease. Fecaluria and pneumaturia are pathognomonic. CT scan is the image modality of choice. Surgical treatment is always warranted and one time repair is currently advocated.

Ascitis y falla renal: no olvidar el uroperitoneo / Ascites and renal failure caused by a bladder fistula: Report of one case

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Congenital ceco-vesical fistula associated with anorectal malformation: Case report

Congenital ceco-vesical fistula [CCVF] associated with high anorectal malformation was not described before. The only described case in 1972 was associated with total colonic atresia which are not the case. We report a case of CCVF associated with a blind ended distal colon in a 50-day old male presented with high imperforate anus faecalurea, and epididymo -orchitis of the left testis. The bladder was separated from the cecum followed by abdomino-perineal pull-through of the colon. The relevant literature is reviewed, and the diagnostic modalities and management are discussed

Vesicocutaneous fistula arising from a bladder diverticulum.

A 55-year-old man presented with intermittent episodes of urinary leak through the left groin following an abscess drainage at that site at the age of 5 years. Since then he had been suffering from recurrent urinary tract infections and urinary leak, which used to be treated symptomatically. Intravenous urogram (IVU), voiding cystourethrogram (VCU), and cystoscopy done in our institution revealed a bladder diverticulum with a stone in situ, which was communicating with the fistulous opening located in the left groin. Diverticulectomy and excision of the fistulous tract cured the patient. A long-standing fistula arising from a bladder diverticulum at relatively distant site is of extreme rarity. Vesicocutaneous fistula from an iatrogenic injury to vesical diverticulum resulting from a groin surgery has not been reported so far.

Pelvic Fistulas Complicating Pelvic Surgery or Diseases: Spectrum of Imaging Findings

Pelvic fistulas may result from obstetric complications, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, pelvic surgery, or other traumatic causes, and their symptoms may be distressing. In our experience, various types of pelvic fistulas are identified after pelvic disease or pelvic surgery. Because of its close proximity, the majority of such fistulas occur in the pelvic cavity and include the vesicovaginal, vesicouterine, vesicoenteric, ureterovaginal, ureteroenteric and enterovaginal type. The purpose of this article is to illustrate the spectrum of imaging features of pelvic fistulas.

Vesico-vaginal fistula: experience of 230 cases.

We reviewed 230 cases of vesico-vaginal fistula in Ramathibodi Hospital from 1969 to 1997. The cases of fistula included 164 cases after transabdominal hysterectomies, 5 cases after anterior colporrhaphies, 8 cases after radical hysterectomy, 23 cases after vaginal hysterectomy, 10 cases after prolonged or traumatic birth, 9 cases after radiation for cervical carcinoma, 7 cases of cervical cancer invasion, 2 cases after suprapubic cystolithotomy and 2 cases after pelvic fracture. Most of them were referred from other hospitals. In 7 cases, the fistula closed spontaneously after indwelling urethral catheters for 4-6 weeks. Five cases were cured after transurethral fulgurations. The rest were treated with different surgical procedures i.e. transvaginal, transvesical and retrovesical repairs. Ten cases were treated by urinary diversions, usually after failure using other surgical procedures.

Sindrome de Youssef: fístula vésico-uterina / Youssef`s syndrome: vesicouterine fistula

As fístulas vésico-uterinas constituem as fístulas urogenitais menos frequentes. Relatamos 2 casos que ocorrem após parto cesária e parto normal com distócia e que foram resolvidos através de acesso abdominal com sucesso. Revisamos também os aspectos diagnósticos e terapêuticos desta entidade

Diagnóstico y manejo de las fistulas vesicocolonicas / Diagnosis and management of vesicocolonic fistulae

En el período que va desde enero de 1993 a diciembre de 1996, se estudian 10 pacientes con fístula vesicocolónica secundaria a diverculitis ( 5 casos), cáncer de colon ( 2 casos), iatrogenia ( 2 casos) y dudoso ( 1 caso). Los síntomas de presentación fueron neumaturia, fecaluria, disuria e infección urinaria. Los exámenes complementarios para el diagnóstico fueron: cultivos de orina, cistografía, colon por enema , urograma exctretor, cistoscopia , fibrocolonoscopia, rectosigmoidescospia y TAC (tomogtafía axial computada). Entre ellos, los más concluyentes y efectivos para el diagnóstico de fístula vesicocolónica resultaron el cultivo fde orina, la cistografía y el colon por enema. El tratamiento en todos los casos fue la cirugía en todos los casos fue la cirugía en un tiempo con resección de la fístula y del segmento de colon afectado, la anastomosis terminoterminal del colon y el cierre simple de la pared de la vejiga. No se registraron recidivas de las fístulas durante el tiempo de observación del estudio

Fístulas urogenitais / Urogenital fistulas

Revisam-se aspectos etiopatológicos, clínicos e diagnósticos das fístulas urogenitais. Conclui-se que, em sua maioria, resultam de eventos iatrogênicos, produtores de soluçöes de continuidade que permitem fluxo urinário de vias urinárias baixas ou altas para o trato genital, Indica-se cuidadosa avaliaçäo diagnóstica de cada caso, individualizando o tratamento. Apenas cerca de 5 por cento de casos tendem à resoluçäo espontânea; nos demais, o tratamento cirúrgico oportunizará a soluçäo definitiva

Lesiones urológicas en la cirugía ginecológica y uroginecológica. Dos años de experiencia institucional / Urological lesions in gynecological surgery, and urogynecological: two years of institutional experience

Informamos la frecuencia de la lesión urológica en la cirugía ginecológica y urogenicológica en el INstituto Nacional de Perinatología de la Ciudad de México, de marzo de 1993 a febrero de 1995. En este período se ralizaron 3,452 cirugía en total, 2.971 fueron ginecológicas y 481 uroginecológicas. Se encontraron 20 pacientes con lesión del tracto urinario inferior. El tipo de lesión más frecuente fue punzante y roma en ocho casos respectiva y cortante en cuatro. En 17 pacientes el diagnóstico de la lesión se hizo en el transoperatorio y en tres pasó inadvertida. La complicación tardía de la lesión fue fístula uretrovaginal en dos, vesicovaginal en una y ureterovaginal una, formación de litos una y retención de sonda transuretral una. El órgano más afectado fue la vejiga en 18 casos, uretero uno y uretra un caso. La lesión del aparato urinario inferior representa 4.15 por ciento de las complicaciones de la cirugía uroginecológica y 0.67 por ciento de la ginecológica. El aspecto fundamental en el pronóstico de la lesión del aparato urinario inferior, es el diagnóstico opotuno de la lesión durante el procedimiento quirúrgico

Benign colovesical fistulae

Two successfully treated cases of benign colovesical fistula are presented. The condition should be suspected whenever patients with colorectal disease develop urinary symptoms. Fllexible colonoscopy and lateral abdominal X-ray should be the initial investigations; but barium enema, cystoscopy and, rarely, CT scan may be necessary to confirm the presence of a colovesical fistula. Patients should be managed conservatively during the acute phase, and then be treated definitively by a single-stage bowel resection. Simple closure or resection and closure is used for the bladder defect.

Fístula vésico-uterina / Vesic uterin fistula

Os autores apresentam os reultados da análise dos dados clínicos, endoscópicos e radiológicos de dois casos de fístula vésico-uterina e ressaltam alguns aspectos da sintomatologia, que näo preenchem as características da "síndrome de Youssef"