Spontaneous Closure of Vesicouterine Fistula

Abstract

Objectives: To analyze the incidence of spontaneous closure, or non-surgical resolution, of vesicouterine fistula and discuss the resultant implications for the management. Methods: Review of the literature supplemented by case report of a young woman with spontaneous healing of vesicouterine fistula. Results: This is the 41st patient with spontaneous closure of vesicouterine fistula reported to date. Her clinical course was suggestive of endocrine involvement in the lesion’s formation. Spontaneous healing was observed in 5% of 796 vesicouterine fistula cases. Induction of amenorrhea was effective in 8 (89%) of the 9 patients treated, a rate significantly higher (p < 0.001) than that observed without hormonal manipulation (4%). Conclusions: Conservative management by means of hormonal treatment should be considered before surgical repair. We suggest the role of estrogens and the endometrium in the formation of vesicouterine fistulas.

Consider the Risk of Vesicouterine Fistula in the Event of Intermittent Fluid Vaginal Discharge after a Cesarean Section

“…Conservative management by the placement of a bladder catheter for 4–6 weeks has been reported for small early diagnosed fistulae (<6 weeks from the causative surgery) ( 20 ) with a complete recovery in 5% of the cases. Simultaneous hormonal manipulation with induction of amenorrhea seems to promote spontaneous healing, as histological examination of fistulous tracts showed epithelial and stroma cells that contain sex hormone receptors as in the endometrium ( 21 ).…”

Robotic-Assisted Laparoscopic Repair of a Vesicouterine Fistula

“…Oral contraceptives, progestational agents, and gonadotropin releasing hormone analogs have been used to induce amenorrhea. 9 Józwik and Józwik 16 discovered that when hormonal suppression was utilized, the likelihood of spontaneous resolution of the fistula was 89% as opposed to <5% without suppression. Cystoscopic fulguration of the vesicular portion of the fistula has also been proven to be effective in specific cases of vesicouterine fistula.…”

Vesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review

“…Hodonou et al 5 reported 17 cases in 7 years in a urologic center in Cotonou, Benin. Jóźwik and Jóźwik, 3 in a review published in 1997, found 602 cases reported in the literature from the 19th century to December 1995; they conducted an additional review (which has not been published), and found 194 additional cases up to December 1997, totalizing 796 cases. 3 The frequency of vesicouterine fistulae in relation to other urogenital fistulae, as previously reported, varies from 1% to 16.4%.…”

“…The latter fistulae are more often of the urethrovaginal or vesicouterine type. 2 Jóźwik and Jóźwik, 3 in a series of 110 genitourinary fistulae collected from 1983 to 1994 in a urologic center in Poland, reported 50.9% of vesicovaginal, 17.3% of ureterovaginal, 13.6% of vesicouterine, and 1.8% of ureterecutaneous fistulae. 1 Currently, it is likely that the relative frequency of vesicovaginal fistulae is even lower than the one reported in the aforementioned series, due to a continuous increase in cesarean section rates worldwide.…”