Surgically correcting a vesicouterine fistula with a myouterine flap. A case report.
BACKGROUND: The incidence of vesicouterine fistula has been increasing, most probably secondary to a corresponding increase in the use of low segment cesarean section. CASE: A 37-year-old woman with a history of two cesarean sections, 14 years and 5 months earlier, presented with urge incontinence, cyclic hematuria and amenorrhea. Hysterosalpingography demonstrated contrast with the bladder and suggested a vesicouterine fistula. Following exploratory laparotomy and dissection of the bladder from the uterus, a fistula was seen connecting the anterior surface of the uterus and the posterosuperior aspect of the bladder. The fistula, with a cuff of uterus and bladder, was excised and the remaining defects repaired. In addition, a myouterine flap was raised to reinforce the repair. Upon follow-up the patient reported no difficulty in urination, complete urinary continence, normal menses and no hematuria. CONCLUSION: This is the first case of vesicouterine fistula repaired with a myouterine flap. This technique strengthens the repair and is especially convenient due to its easy accessibility. A myouterine flap can be utilized if the omentum is of insufficient length or absent. The risk of postoperative bowel obstruction may be decreased as compared to omental interposition.