Purkait Bimalesh, Mehrotra Seema, Sinha Rahul Janak, Bhaskar Ved, Singh Vishwajeet
Department of Urology, King George Medical University, Lucknow, India.
Department of Gynecology and Obstretics, King George Medical University, Lucknow, India.
Turk J Urol. 2017 Dec;43(4):512-516. doi: 10.5152/tud.2017.45389. Epub 2017 Dec 1.
Vesicouterine fistula (VUF) is an uncommon cause of female genito-urinary fistula. Most of these fistulas are due to lower segment uterine cesarean section (LSCS). Traditionally, open surgical repair has been the traditional treatment. However, laparoscopic repair of VUF is a minimally invasive technique and few case reports have been published with short term follow up. In the present study, we are presenting our long- term outcome of laparoscopic repair of VUF.
A retrospective analysis of 8 patients with VUF was performed from 2010 to 2015. Approval of Institutional Review Committee was obtained. All had history of LSCS of whom 3 had history of prolonged obstructed labor. Radiological imaging included ultrasound of kidney, ureter and bladder for all patients and hysterosalphingography in 4 patients and contrast enhanced computed tomography scan in 4 patients.
Median age of the patient was 25.5 years (range, 22-32), and median follow up was 2.3 years (range, 1 -4). The most common presentation was cyclical menstrual bleeding through urine (menouria) in all, associated amenorrhea in 6 and vaginal leakage of urine in 2 cases. All patients underwent laparoscopic repair with successful outcomes. The mean operating time was 155±14.5 min (range, 135-186 min) with a median blood loss of 100 mL (range, 50-210 mL). Successful pregnancy was completed in 2 patients and other patients were taking contraceptives.
Laparoscopic repair of VUF is a safe and effective minimally invasive technique with successful pregnancy in long- term follow up.
膀胱子宫瘘（VUF）是女性生殖泌尿系统瘘的一种罕见病因。这些瘘管大多是由于子宫下段剖宫产术（LSCS）所致。传统上，开放手术修复一直是常规治疗方法。然而，VUF的腹腔镜修复是一种微创技术，仅有少数短期随访的病例报告发表。在本研究中，我们展示了VUF腹腔镜修复的长期结果。
对2010年至2015年期间8例VUF患者进行回顾性分析。获得了机构审查委员会的批准。所有患者均有LSCS病史，其中3例有产程延长受阻病史。影像学检查包括对所有患者进行肾脏、输尿管和膀胱超声检查，4例患者进行子宫输卵管造影，4例患者进行增强CT扫描。
患者的中位年龄为25.5岁（范围22 - 32岁），中位随访时间为2.3年（范围1 - 4年）。最常见的表现是所有患者均有周期性经尿道月经出血（经期尿血），6例伴有闭经，2例有尿液经阴道漏出。所有患者均接受了腹腔镜修复，结果成功。平均手术时间为155±14.5分钟（范围135 - 186分钟），中位失血量为100毫升（范围50 - 210毫升）。2例患者成功妊娠，其他患者采用避孕措施。
VUF的腹腔镜修复是一种安全有效的微创技术，长期随访中有成功妊娠的病例。
