Intravesical contrast-enhanced ultrasound (CEUS) for the diagnosis of vesicouterine fistula (VUF)

Abstract

Background:Vesicouterine fistula (VUF) is a very rare type of urogenital fistula, the incidence of which has increased in recent years due to increased cesarean section deliveries and other pelvic surgeries. The clinical diagnosis of VUF is typically challenging.Case:A 31-year-old woman who presented with fever, increase urine frequency, and urinary incontinence at night, along with occasional vaginal discharge after cesarean section. The VUF was misdiagnosed on conventional ultrasound, but was successfully diagnosed by using intravesical contrast-enhanced ultrasound (CEUS) using SonoVue, which was confirmed by the subsequent cystoscopy.Conclusion:Intravesical CEUS provides a new effective method for diagnosing VUF, which may become the first choice for diagnosing urogenital fistulas.

Trans-intrauterine contrast-enhanced ultrasound (CEUS) can be an effective approach for the diagnosis of vesicouterine fistula (VUF), especially for patients with fistulas flowing unidirectionally from the uterine cavity

“…Currently, the commonly used contrast agent is Sonovue (Bracco, Italy), its main component is sulfur hexafluoride (SF 6 ) gas microbubble, which is exhaled from the lungs, hypoallergenic and does not damage the liver or kidneys. Sun et al reported a successful diagnosis of VUF by intravesical injection of SonoVue through a catheter into the bladder [ 6 ]. In the present case, VUF occurred after cesarean section.…”

Vesicouterine fistula presenting with cyclical haematuria mimicking bladder endometriosis: A case report

“…If the presence of VUF is above the internal uterine ostium, it may be linked to amenorrhea, decreased urinary leakage, and cyclic haematuria. In contrast, VUF encompassing the cervix is generally depicted by urinary leakage and uninterrupted menstrual cycle [ 6 , 17 ]. The absence of urinary incontinence might be due to the functional valve made by the isthmic sphincter that also causes the menstrual blood flows into the bladder.…”

“…A surgical approach is contemplated the mainstay and definitive management of the VUF following caesarean section [ 17 ]. Notably, a subset of women was able to resume a normal period after fistula repair [ 14 ], though the data on how frequently this occurs is very limited [ 2 , 10 , 14 ].…”

Assessment of Additional MRI-Detected Breast Lesions Using the Quantitative Analysis of Contrast-Enhanced Ultrasound Scans and Its Comparability with Dynamic Contrast-Enhanced MRI Findings of the Breast

“…CEUS is done in a relatively more comfortable supine position, and uses contrast agents that do not put renal function at risk ( 10 ). In addition, CEUS is able to dynamically observe the perfusion changes as opposed to multiple static images of DCE-MRI ( 11 ).…”