July 2020 · Volume 9 · Issue 7 Page 3084 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Singh S et al. Int J Reprod Contracept Obstet Gynecol. 2020 Jul;9(7):3084-3086 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Vesicouterine fistula: a case report Swati Singh 1 *, Vijayata Sangwan 1 , Kulvinder Singh 2 , Atul Khandelwal 3 INTRODUCTION Vesicouterine fistula (VUF) is a rare urogynecological fistula and represents about 1-4% of all cases of urogynecological fistula. 1 It is usually iatrogenic following caesarean section in about 83-93% of cases. 2,3 The incidence of vesicouterine fistula is increasing with rising number of caesarean section. 4 These injuries occur 2 times more often after repeat caesarean sections. 5,6 Some of the risk factors for the development of VUF are inadequate reflection of bladder from lower uterine segment, excessive intraoperative bleeding, severe dystocia, forceps delivery, uterine rupture, previous caesarean section. Authors report a case of successful conservative management of vesicouterine fistula. CASE REPORT A 28-year-old multiparous patient underwent a repeat lower segment caesarean section at 36 weeks 4 days gestation for scar tenderness. Delivery was uneventful, although bladder was adherent to lower uterine segment, and sear dehiscence was noted. Foley’s catheter was inserted at the time of caesarean section, and removed after 24 hours. Also, PPIUCD was inserted at the time of LSCS. The patient then reported urinary urgency and frequency. Based on these finding, urine culture sensitivity was done. Urinary infection was diagnosed, antibiotics commenced and the patient discharged. Figure 1: CT scan of vesicouterine fistula. Ten days later, she presented to labour room with urinary frequency, urgency, haematuria, suprapubic discomfort and urinary incontinence. On examination, incision site was healthy. Abdomen was distended and tender. Bowel sounds were normal and the uterus was well contracted. Vaginal examination was normal, with normal lochia. Ultrasound demonstrated free fluid in pouch of douglas and some fluid in the uterine cavity. Repeat urine ABSTRACT Vesicouterine fistula represents a rare urogenital fistula, accounting for approximately 1-4% of genitourinary fistulas. Iatrogenic reasons have been shown to be most common cause. Surgical excision is the mainstay of treatment. Less than 5% patients respond to conservative management. Authors report a case of successful conservative management of vesicouterine fistula. Keywords: Caesarean section, Ultrasound, Vesicouterine fistula 1 Department of Obstetrics and Gynecology, BPS GMC, Khanpur Kalan Sonepat, Haryana, India 2 Department of Radiology, BPS GMC, Khanpur Kalan Sonepat, Haryana, India 3 Department of Urology, BPS GMC, Khanpur Kalan Sonepat, Haryana, India Received: 11 May 2020 Accepted: 04 June 2020 *Correspondence: Dr. Swati Singh, E-mail: swati0019singh@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20202766