Editing Functional: Urinary Fistulae (section)

=== Vesicouterine fistula ===

* Among the least common urogynecologic fistulae

==== Causes ====
*'''<span style="color:#ff0000">Most common cause: Cesarean section</span>'''
** Simultaneous injury to the bladder and uterus is the enticing event

==== Diagnosis and Evaluation ====
*'''History and Physical Exam'''
**'''Unlike other types of urogynecologic fistulae, vesicouterine fistulae may or may not manifest with constant urinary incontinence because of the sphincter-like activity of the cervix:'''
*** '''Exception is in the setting of an incompetent cervix (e.g. post-partum period) wherein urinary leakage is constant'''
*'''Imaging'''
**'''Radiographic studies'''
*'''Other'''
**'''Cystoscopy'''

==== Management ====
* '''Prolonged indwelling bladder catheterization or fulguration of the fistula tract''' followed by bladder drainage may be successful in select cases, especially in patients with small, immature fistulae.
* '''Hormonal induction of menopause''' will induce involution of the puerperal uterus, and this principle has been used with some success in treating this condition.
* Surgical therapy for vesicouterine fistulae is often contingent on the specific reproductive wishes of the patient. If there is no further desire for childbearing, then transabdominal hysterectomy and bladder closure should be considered. For the patient who desires preservation of fertility, uterine-sparing surgery can be considered