EP118 - Chronic Vesicouterine Fistula (Youssef's syndrome) Complete Opening of Anterior Uterine Wall in the Urinary Bladder: A- very rare case

Abstract Background Vesicouterine fistula is an uncommon urogenital condition typically following Caesarean sections (C/S). Youssef syndrome, characterized by haematuria, amenorrhea, and urinary incontinence, poses a diagnostic challenge and demands comprehensive assessment. Case report We present a case of a 40-year-old woman with persistent urine incontinence and haematuria for three years post her fourth C/S. Clinical evaluation revealed periodic lower abdominal pain, haematuria, amenorrhea, and urine incontinence. sonography was normally reported, while cystoscopy revealed a complete 5x2 cm opening between the anterior uterine wall and the posterior bladder wall, confirming Youssef syndrome. After a course of antibiotic therapy, surgical intervention was planned. Transabdominal total hysterectomy, partial cystectomy, and repair were performed following meticulous anatomical delineation using cystoscopy. The procedure involved dissecting the vesicouterine attachment, performing partial cystectomy, and eventually total hysterectomy. Closure of the urinary bladder defect with absorbable sutures and a negative leak test concluded the surgery. The patient showed no postoperative complications, with follow-ups at 6 and 12 months indicating complete recovery without complaints.