title: Conservative management of vesicouterine fistula after uterine rupture.
abstract: We report the closure of a vesicouterine fistula with conservative management utilizing an indwelling transurethral Foley catheter. Uterine rupture occurred during a trial of vaginal birth after cesarean section, necessitating an emergency cesarean section. Upon entry into the abdomen, the base of the bladder was noted to be involved in the uterine rupture. The bladder trigone and ureteral orifices appeared normal. A primary, two-layer bladder repair was performed. A cystogram on postoperative day 14 demonstrated a vesicouterine fistula. Conservative management involving bladder drainage for 21 days with a transurethral Foley catheter was successful in closure of the fistula. Vesicouterine fistula, a documented complication of uterine rupture due to attempted vaginal birth after previous cesarean section, can spontaneously resolve with conservative management alone.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania, 5 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA. jnovi@obgyn.upenn.edu
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Novi
authors.forename: Marisa
authors.initials: M
authors.lastname: Rose
authors.forename: Alka
authors.initials: A
authors.lastname: Shaunik
authors.forename: Parvati
authors.initials: P
authors.lastname: Ramchandani
authors.forename: Mark A
authors.initials: MA
authors.lastname: Morgan
mesh_terms: D000328:Adult; D005260:Female; D005402:Fistula / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods; D014591:Uterine Diseases / Q000209:etiology / Q000628:therapy; D014597:Uterine Rupture / Q000150:complications*; D016064:Vaginal Birth after Cesarean