An unusual presentation of a vesicouterine fistula

Abstract

A 26-year-old female presented with a history of cyclical incontinence following a ventouse assisted delivery. Initial investigations revealed an endometrial deposit in her bladder, which following further investigations revealed a vesicouterine fistula necessitating formal open repair.

Letter to the editor re: ‘Youssef’s syndrome: should MRI be the first line investigation?’

“…She required a videourodynamic evaluation and clinical correlation with a repeat MRI before a definitive diagnosis was reached, following a negative cystogram and gynaecological laparoscopy. 2 Our case differs from the one described by Williams et al 1 as we preserved the uterus, repaired the fistula with an omental patch and left the catheter in situ for six weeks. The patient has subsequently become pregnant.…”

“…1 Several modalities can be used in an attempt to reach a diagnosis; it is accepted that MRI is the most accurate diagnostic tool but cystography is unreliable due to the pressure difference between the uterus and bladder. 2– 4 As some patients may inadvertently present to a haematuria clinic, an accurate, focussed history is essential and in keeping with the recommendation of Williams et al 1 we would agree that MRI should be considered as a first line investigation in cases of suspected vesicouterine fistulae as it may expedite the diagnosis and avoid unnecessary radiation.…”