Youssef’s Syndrome: An Appraisal of Hormonal Treatment

Abstract

Two cases of vesicouterine fistula, caused by lower-segment cesarean section, are presented. Both cases had classical symptoms of Youssef’s syndrome, i.e. cyclic hematuria, absence of vaginal bleeding and complete urinary continence. These patients were treated by the continuous administration of an estrogen-progestogen combination for 6 months. However, it failed in 1 case requiring transabdominal transperitoneal closure of the fistula with an interposition of omentum. We feel that hormonal treatment may be tried as first modality in the treatment of Youssef’s syndrome, before resorting to surgery.

Evaluating Menouria-Comparison of X-Ray Cystography and Hysterography

“…The phenomenon was also observed in this series where contrast was imme- diately leaking to bladder on administration through internal os but the reverse was not observed. It is postulated to be due to high intra-uterine pressure as compared to the intra-vesical pressure 16 . This was the most likely reason for the non-specific cervical leakage of contrast that was visible on real time fluoroscopy only.…”

“…Complete preoperative emptying of bladder, adequate intraoperative reflection of bladder from uterus, and timely recognition and repair of the bladder injury helps to prevent it 11 . Spontaneous closure and hormonal therapy has been reported 5,6,16 . Majority recommends surgical repair 6,7,11,12 .…”

Successful management of vesicouterine fistula by luteinizing hormone‐releasing hormone analog

“…In the reminder case, ovarian irradiation was applied for estrogen suppression to induce amenorrhea. 9 Hemal et al 10 reported one case with a relatively large vesicouterine fistula measuring 12 mm in diameter, which was not closed by hormonal therapy, and required surgical repair. Although large fistulas may often require surgical repair, small fistulas caused by cesarean section can be closed by hormonally induced amenorrhea.…”

Spontaneous Closure of Vesicouterine Fistula

“…In the present study, induction of amenorrhea by hormonal manipulation was shown to be highly effective. The only patient in whom hormonal treatment had failed was one receiving high doses of estrogen (50 Ìg ethinyl estradiol) daily [29]. Protrusion of the endometrium through the fistula to the vesical lumen has been described [29,34].…”

“…Hemal et al [29] described one successful case of such medical treatment, and one failure followed by surgical repair. Induction of amenorrhea with an LHRH analog also proved effective [25].…”