Vesicouterine fistula--an analysis of 24 cases from Poland.

OBJECTIVE

This study was undertaken to evaluate what clinical events or situations are currently associated with the occurrence of vesicouterine fistula.

METHOD: A retrospective investigation was carried out on 24 patients treated in a tertiary referral center during a 12-year period. Clinical data were collected from the patients directly, the medical records, urographic and/or cystoscopic findings before repair and intraoperative findings at repair.

RESULTS

All fistulas were iatrogenic, and 21 (87.5%) occurred following cesarean section or cesarean hysterectomy. Bladder injury occurred two times more often after repeat operations than after the primary. The proportion of repeat cesarean section resulting in a fistula was significantly increased (58.3% vs. 29.6%, P < 0.013) when compared to that previously reported.

CONCLUSIONS

Cesarean sections are currently the single major risk factor associated with the occurrence of vesicouterine fistulas. Repeat procedures increase the risk of bladder injury and resultant fistulas.