A 31-year-old female sought termination of pregnancy due to a fetal body stalk anomaly diagnosed at 18 weeks of gestation. Despite an anterior placenta previa, successful vaginal delivery occurred. However, placental adhesion over a previous cesarean scar occurred, and part of the placenta could not be removed. Immediate postpartum bleeding prompted imaging studies, revealing extravasation from adherent placental remnants. Uterine artery embolization (UAE) provided initial hemostasis, but recurrent bleeding necessitated re-embolization. Although conservative treatment was initially pursued, significant hematuria prompted reevaluation, revealing extensive uterine wall and bladder penetration. Surgical intervention with total hysterectomy and partial bladder resection was performed, leading to the successful recovery of bladder function following surgical repair. While this case achieved a positive outcome, there is a potential for permanent urinary dysfunction if lesions are more extensive. While achieving a conservative cure is ideal, it is essential to assess the timing for opting for surgical intervention.

Vesicouterine fistula is a rare complication occurring mainly after cesarean sections. We present here a particular case of vesicouterine fistula (VUF) whose only symptom was urinary incontinence. We describe the diagnostic methods used and the surgical treatment used to resolve the case. A 30-year-old woman presented to the gynecology clinic with urinary incontinence that occurred 5 days postoperatively after a cesarean section. The diagnosis was made on the basis of computed tomography and cystoscopy. Treatment was surgical and consisted of excision of the fistula and suturing of the bladder and uterine wall, without interposition of the omentum. Postoperative evolution was uneventful. When the urethral catheter was removed on the 14th postoperative day, the patient presented spontaneous micturition without vaginal urine leakage. In the context of urinary incontinence after cesarean section, although it is a rare complication, we must consider the occurrence of a VUF.

BACKGROUND: Vesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.
OBJECTIVE: To assess current evidence on VUF pathogenesis and surgical management.
METHODS: Pubmed and Embase databases were searched from January 2000 to January 2023 using relevant key words.
METHODS: Only original articles including either transabdominal or transvaginal surgical routes for post-cesarean VUF repair, in English language, were included.
METHODS: Two authors independently screened the references for eligibility, data extraction, and assessment of methodologic quality. All available surgical outcomes were recorded.
RESULTS: Of the 1160 studies retrieved, 67 were selected for analysis. Most of these were case reports, case series, or observational cohort studies including a total of 284 patients. The majority (78.6%) of patients had more than one cesarean section, and approximately 10% of them experienced an overt bladder injury and/or uterine rupture at the time of cesarean delivery. The supratrigonal part of the bladder was most commonly involved (92.5%). The majority of patients (88.8%) underwent delayed VUF repair through laparotomy. Length of stay and blood loss were significantly less in patients treated via a minimally invasive approach (P < 0.001 and P = 0.02, respectively). Most patients had double-layer bladder repair and single-layer uterine repair. The overall success rate was 100% on first attempt for each independent combination of different surgical approaches and techniques. Live birth following VUF repair was reported in 23 patients.
CONCLUSIONS: Paying close attention to surgical details is crucial to reduce the incidence of this complication and recurrence rates. Double-layer bladder closure and delayed timing of repair of VUF are recommended.

BACKGROUND: Vesicouterine fistula (VVF) is a rare disease. In 83-93% of cases it develops due to caesarean section. VVF is characterized by non-physiological communication between the bladder and the uterus. This disorder has a significant social impact, causing incontinence, persistent medical and psychological maladaptation. The gold standard for treating VVF is surgical reconstruction. Early and late results of minimally invasive approaches do not differ from open procedure, but only if the surgical team has sufficient experience.
OBJECTIVE: To evaluate the efficiency of surgical treatment of VUF using a minimally invasive technique.
METHODS: From 2010 to 2021 a total of 15 patients with VVF were treated. The age of the patients varied from 18 to 37 years (mean 26.4 years). The average body mass index was 26.3 kg/m2. The mean maximum fistula diameter was 10.7 mm (from 2 to 25 mm). The predominant cause of VVF was cesarean section (93%; n=14). In one case (7%), radiation-induced VVF was seen. Patients were randomized according to the Jwik and Jwik classification based on clinical manifestations. A type I of VVF was diagnosed in 4 patients (27%), type II in 9 patients (60%), type III in one woman. Recurrent urinary tract infection was observed in 53% (n=8) of cases. Four women were complaint of chronic pelvic pain syndrome (27%). The pain score on VAS did not exceed 6 points. All patients were undergone to minimally invasive procedures, including robot-assisted approach (n=5; 33%) and laparoscopic access (n=10; 67%).
RESULTS: During the follow-up from 4 weeks to 10 years there was no recurrence of VVF. No indications for hysterectomy were found in any of the cases, however, it was carried out in two women after obtaining the informed consent. The average duration of robot-assisted procedure was 118 min (80-140), compared to 125.5 min (90-160) for laparoscopic access (p>0.05). The average length of stay after robotic procedure was 5.2 days (range 4 to 8 days) and 6.7 days (from 5 to 10 days; p> 0.05), respectively. Intraoperative blood loss did not exceed 130 ml. The mean value for laparoscopy was 97 ml, compared to 82 ml for robot-assisted approach (p>0.05). In both groups, there were no intra- and postoperative complications according to the Clavien-Dindo classification. Thus, there was no significant difference in the results of VVF closure between robot-assisted and laparoscopic approaches.
CONCLUSIONS: The results of minimally invasive surgical reconstruction of VVF do not differ from open procedure and depend on timely diagnosis, adherence to strict surgical techniques, and surgical experience, regardless of the approach.

Vesicouterine fistulas are an extremely rare fistula occurring between the bladder and uterus and most commonly occur after lower segment cesarean sections. There are fewer than 100 case reports documenting vesicouterine fistulas, with most managed with open or laparoscopic surgical techniques. We present a novel case, including diagnostic evaluation and robotic-assisted repair, of a simultaneous vesicovaginal and vesicouterine fistula that developed after a uterine rupture that was complicated by multiple cystotomies. A robotic approach affords good visibility of the deep pelvis while still allowing for mobilization of the omentum as an interposition graft, with the benefit of a minimally-invasive approach.

Here, we report a 41-year-old female with type II VUF after hysteromyomectomy.We report the diagnosis of VUF by imaging method, and provide a feasible treatment for this complication after pelvic surgery.

METHODS: Vesicouterine fistula (VUF) is the rarest form of genitourinary fistulas. As lower-segment cesarean section becomes a more common mode of delivery, they have become the leading cause of VUF formation. We present four VUF patients with varied symptoms such as menouria, amenorrhea, with or without urinary incontinence. We diagnosed all of our cases through cystoscopy in conjunction with methylene blue dye test or hysteroscopy.
RESULTS: We successfully repaired VUF in three open surgery instances and one laparoscopic case. To diagnose VUF, cystoscopy and hysteroscopy are still the gold standard. An expert surgeon\'s open or laparoscopic repair is effective and safe. The patients no longer experienced incontinence, cyclical hematuria (menouria), discomfort, or sexual dysfunction.
CONCLUSIONS: Cystoscopy and hysteroscopy remain the gold standard tool in diagnosing VUF. Open or laparoscopic repair performed by an experienced surgeon is an effective and safe technique with a successful outcome.

Vesicouterine fistula (VUF) also called Youssef\'s syndrome is a rare and the least commonly encountered entity among genitourinary fistulae. Treatment options range from excision of the fistulous tract with hysterectomy and primary closure of the urinary bladder to fistula repair. Migrated postpartum intrauterine contraceptive device is one of the rarest causes for VUF. Here, we are describing a case of incidentally diagnosed VUF with Type 2 Youssef\'s syndrome with migrated postplacental (postcesarean) intrauterine contraceptive device, treated with uterus-sparing laparoscopic VUF closure.

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OBJECTIVE: Surgical repair of vesicouterine fistula (VUF) can be performed through transvaginal and transabdominal routes. Transvaginal repair of VUF has been rarely reported. This study is aimed at demonstrating the feasibility and experience of transvaginal repair of VUF, and presents a step-by-step concrete surgical technique.
METHODS: We presented a video of a 36-year-old woman who developed VUF after a second cesarean section. The patient underwent a transvaginal surgical repair in the prone jackknife position. We also presented the clinical data of another two patients with VUF, and summarized the experience of all three patients in whom the same technique was performed.
RESULTS: The operative times of the three patients were 120, 200, and 180 min respectively. No surgical complications were observed. After a follow-up of 2-3.5 years, none of the patients had vaginal leakage.
CONCLUSIONS: Transvaginal repair of VUF in the prone jackknife position is a feasible and effective procedure for restoring the anatomy. However, there is still a need for well-designed studies with a large number of patients to identify the most promising approach.