Vesicouterine fistula following multiple cesarean sections: A case report

Introduction: Vesicouterine fistula, also known as Youssef’s syndrome, is a rare but significant complication primarily arising after cesarean sections. This condition involves an abnormal connection between the bladder and the uterus, which can lead to symptoms such as cyclic hematuria (menstrual blood in the urine) and urinary leakage. The increasing incidence of cesarean deliveries highlights the need for greater awareness and effective management of this condition. Case Report: We present the case of a 32-year-old woman with a history of multiple cesarean sections who was admitted with spontaneous labor at 36 weeks and 4 days of amenorrhea. Initial diagnostic imaging and clinical assessment indicated a viable pregnancy but revealed a history of extensive intra-abdominal adhesions. During an emergency cesarean section, complications included a bladder injury and a 2 cm uterine rupture. Post-operatively, the persistent presence of hematuria led to further investigation using retrograde urethrocystography (UCR), which confirmed the diagnosis of a vesicouterine fistula. The diagnosis of vesicouterine fistula presents significant challenges due to its rarity and the overlap of symptoms with other conditions such as malignancies or bladder injuries. The condition is often associated with difficult cesarean sections and extensive intra-abdominal adhesions. Accurate diagnosis relies on imaging techniques, particularly UCR, to identify the fistula and guide appropriate surgical intervention. Effective management includes careful surgical repair and post-operative monitoring to resolve the fistula and restore normal bladder and uterine function. Conclusion: Vesicouterine fistula is a rare but important complication following cesarean sections, requiring prompt recognition, and management. Awareness of its symptoms and the potential for occurrence in patients with a history of multiple cesarean deliveries is essential for early diagnosis. Imaging modalities, such as UCR, are crucial for accurate diagnosis and guiding surgical treatment. Early intervention and careful post-operative care are key to achieving favorable outcomes and preserving reproductive health.