Lent V, Laaser M
Abteilung für Urologie, St. Nikolaus Stiftshospital Andernach.
Aktuelle Urol. 2005 Feb;36(1):61-3; quiz 65-6. doi: 10.1055/s-2004-830021.
Uterovesical fistulas belong to the least common types of urogenital fistulas. Although uncommon, they cannot be considered a rarity in view of about 800 published cases in the literature. They are most frequently caused by repeated caesarean sections, which are increasing, and their complications can be expected to increase as well.
During the second caesarean section of a 31-year-old woman, the urinary bladder was opened and subsequently closed by a urologic surgeon. In the following weeks and months, the patient suffers from urinary incontinence in response to bladder filling, cyclic hematuria (menouria) and recurrent cystitis. After multiple examinations without establishing a diagnosis, an uterovesical fistula was suggested by cystoscopy and confirmed by cystography. The fistula, which measured 2 cm in diameter, was successfully closed by transperitoneal approach without interposition of omentum.
Uterovesical fistulas are to be expected to increase due to an increasing rate of repeated caesarean sections. They can be suggested by their typical symptoms, easily diagnosed by imaging examinations and successfully treated by transperitoneal closure.
子宫膀胱瘘属于泌尿生殖瘘中最不常见的类型。尽管不常见，但鉴于文献中已发表约800例病例，它们也不能被视为罕见病例。其最常见的病因是剖宫产次数增加，预计其并发症也会随之增加。
一名31岁女性在第二次剖宫产手术过程中膀胱被切开，随后由一名泌尿外科医生进行了缝合。在接下来的几周和几个月里，患者出现膀胱充盈性尿失禁、周期性血尿（月经性血尿）和复发性膀胱炎。经过多次检查仍未确诊，膀胱镜检查提示子宫膀胱瘘，膀胱造影予以证实。直径为2cm的瘘管经腹膜入路成功闭合，未使用大网膜。
由于剖宫产次数增加，子宫膀胱瘘的发病率预计将会上升。根据其典型症状可作出推测，通过影像学检查易于诊断，并可经腹膜闭合成功治疗。
