Etedafe P. Gharoro, Ehigha J. Enabudoso, Edafe E. Gharoro
Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria.
PEPFAR, University of Benin Teaching Hospital, Benin City, Nigeria.
DOI: 10.4236/ojog.2013.37099   PDF    HTML   XML   3,537 Downloads   5,553 Views   Citations

Abstract

Vesico-vaginal fistula is still a major problem in the developing world, in particularNigeria. Vesico-uterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than previously thought. We report a case of Mrs U.B. a 28-year-old P2+⁰ with one living child, who presented with a history of 2⁰ amenorrhea and infertility of 8 years duration. She had caesarean section to relieve an obstructed labor with macerated stillbirth in her last pregnancy. As part of her routine investigation for 2⁰ amenorrhea and infertility, a request for ultrasound scan was made. Ultrasound pictures are presented and discussed. Standard diagnostic investigations for Youssef’s syndrome are by cystoscopy, intravenous urogram and or hysterosalpingography, sonodiagnosis (sonohysterography) is primarily not resorted. We recommend as a standard investigation tool, Ultrasound scan (Sonodiagnosis) for all patients with Vesicovaginal fistula.

Keywords

Vesico-Vaginal Fistula; Vesico-Uterine Fistula; Youssef’s Syndrome; Ultrasound Scan; Sonohysterography

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1. INTRODUCTION

1.1. Background

Vesico-vaginal fistula is still a major problem in the developing world, in particular Nigeria. Vesicouterine fistula (Youssef’s syndrome) following relief of obstructed labor by caesarean section is commoner than previously thought. Standard diagnostic investigations for vesicouterine fistula are by cystoscopy, intravenous urogram and or hysterosalpingography, sonodiagnosis (sonohysterography) is primarily not resorted.

1.2. Case Report

We report a case of Mrs U.B. a 28-year-old P2+⁰ with one living child, who presented with the history of 2⁰ amenorrhea and infertility of 8 years duration. In the year 2004 during her last pregnancy and delivery, she had caesarean section to relieve an obstructed labor with macerated stillbirth. Post operative period was complicated by wound sepsis and breakdown.

She has visited numerous health facilities for treatment of her amenorrhea with no successful outcome. On presentation she had no urinary incontinence and has not observed any haematuria. As part of her routine investigation for 2⁰ amenorrhea and infertility, a request for ultrasound scan was made. A scan was done using a 3D ultrasound scan machine (Samsung MySonoU5 with a 3D2-6 probe).

Figure 1 shows the urinary bladder partially filled with urine with a fistulous communication between the uterus and (L) adnexia (Arrowed-white). The uterine endometrial cavity is visualized distended with urine (hypoechoic collection). The cervix is completely closed by fibrosis seen as hyperechoic structure.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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