Vesicouterine fistula: report on 15 cases at Cotonou University Urology Clinic

OBJECTIVE: To analyse the clinical and radiological features of cases of vesicouterine fistula (VUF) seen in the department and the results of treatment in order to improve the therapeutic management of patients with VUF. MATERIAL AND METHODS: The medical records of 17 woman admitted to the department and treated for vesicouterine fistula between 01/01/1994 and 15/06/2001 were reviewed. Two were excluded from this essentially retrospective study, as they were considered to be uninterpretable due to missing data. Predefined forms comprising the parameters indicated in the text constituted the basis of this study. RESULTS: The authors indicate that VUF is a rare disease: 17 cases in 7 and a half years. Detailed review of 15 cases showed that the constant presenting complaint is permanent urine leak from the cervix. It was isolated in 12 cases and associated with "vesical menstrual periods" in 3 cases. Women between the ages of 30 and 39 years were the most frequently affected. Pauciparous women were more frequently affected (7 out of 15 cases). Caesarean section was incriminated in 14 out of 15 cases. 11 out of 15 subjects consulted after at least one year of symptoms. The margins of the fistula were fibrotic in 11 cases, which did not prevent satisfactory results, with 14 cures out of 15 cases after the first surgical operation. CONCLUSION: VUF is an uncommon and very frequently iatrogenic disease, in which the presenting complaint is permanent urine leak from the genital tract, either isolated or associated with cyclic haematuria. Even when patients are seen late, with fibrotic margins, surgical treatment of VUF achieves a good cure rate. The best treatment is prevention, based on a perfect caesarean section technique.