SURGICALLY CORRECTING A VESICOUTERINE FISTULA WITH A MYOUTERINE FLAP - A CASE-REPORT

BACKGROUND: The incidence of vesicouterine fistula has been increasing , most probably secondary to a corresponding increase in the use of lo w segment cesarean section. CASE: A 37-year-old woman with a history o f two cesarean sections, 14 years and 5 months earlier, presented with urge incontinence, cyclic hematuria and amenorrhea. Hysterosalpingogr aphy demonstrated contrast with the bladder and suggested a vesicouter ine fistula. Following exploratory laparotomy and dissection of the bl adder from the uterus, a fistula was seen connecting the anterior surf ace of the uterus and the posterosuperior aspect of the bladder. The f istula, with a cuff of uterus and bladder, was excised and the remaini ng defects repaired. In addition, a myouterine flap was raised to rein force the repair. Upon follow-up the patient reported no difficulty in urination, complete urinary continence, normal menses and no hematuri a. CONCLUSION: This is the first case of vesicouterine fistula repaire d with a myouterine flap. This technique strengthens the repair and is especially convenient due to its easy accessibility. A myouterine fla p can be utilized if the omentum is of insufficient length or absent. The risk of postoperative bowel obstruction may be decreased as compar ed to omental interposition.