[Vaginal repair of a vesico-uterine fistula type I (Jozwik) after caesarean section].

The development of a vesico-uterine fistula is a problem which occurs with an increasing number of caesarean sections. The main symptoms are permanent urinary incontinence, cyclic hematuria ("menouria") and amenorrhoea. In only 5 % of cases, spontaneous closure with bladder catheterization over weeks and hormonal management is possible, most of the time a surgical procedure is the definitive treatment. Until now, the resection of this kind of fistula was performed using a transabdominal approach most of the time. Our procedure describes a surgical repair using a transvaginal approach by exciding the fistula out of the bladder and uterus with primary closure. In this way, a recurrent laparotomy with all known associated risks could be avoided. However, after definitive treatment of the fistula, a new pregnancy should be delivered by performing a caesarean section. In this way, a rupture of the uterus during delivery could be prevented.