Vesicouterine fistula: a review of eight cases.

Eight cases of vesicouterine fistula (VUF) (obstetrical etiology in six cases and inflammatory bowel disease in two) have been treated in the past 14 years. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2-24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.