Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef’s syndrome)

Abstract

E913case report AbstractVesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only 1-4% of all genitourinary fistulas; 90% of cases are Youssef syndrome, which is accompanied by amenorrhea and cyclic hematuria (menouria). In this article, a renal transplant donor who was incidentally diagnosed with Youssef syndrome 20 years after a second cesarean delivery.

A Case of Type 2 Youssef’s Syndrome following Caesarean Section for Placenta Previa Totalis

“…In previous years, it used to be regarded as a complication of assisted delivery applications like vacuum and forceps techniques. Today, 83–93% of VUFs are observed after caesarean delivery [ 4 , 5 ]. Less frequently, this syndrome is observed following hysteroscopy as a complication of dilatation and curettage.…”

“…Certain risk factors for VUFs are insufficient dissection of the bladder from the uterine subsegment, excessive intraoperative bleeding, the use of forceps and vacuum, placenta previa totalis, placental insertion abnormalities (acreata, inreata, and percerata), uterine rupture, previous caesarean section, and history of repeated abortions. Other less frequent causes are endometriosis, inflammatory bowel diseases, migration of the intrauterine devices, bladder tuberculosis, and congenital anomalies [ 5 , 6 ]. In our case, the possible underlying mechanisms that caused VUF could be both caesarean delivery and excessive intraoperative bleeding due to placenta previa totalis.…”

“…VUFs may appear in different clinical presentations like amenorrhea, cyclic haematuria, pelvic pain, secondary infertility, and recurrent pregnancy losses, with or without involuntary urinary incontinence [ 4 , 5 ].…”

“…While classic Youssef triad (the lack of amenorrhea, menouria, and urinary incontinence) is observed in the fistulas above the uterine isthmic level, menstruation is accompanied by urinary incontinence in the fistulas below it (incompetent cervix). That there is urinary incontinence from time to time in some cases is subject to the exceeding of the intrauterine pressure by the intravesical pressure and the drainage of the urine flow into the uterus from an incompetent cervix [ 1 , 5 – 7 ].…”

“…In our case, urinary incontinence was accompanied by other intermittent symptoms like pelvic pain, haematuria, and amenorrhea. However, cases with congenital development anomalies were found in the literature as well as those that were totally incidental [ 5 , 9 ].…”