title: Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis.
abstract: A vesicouterine fistula is a rare form of urogenital fistula, yet there is increasing prevalence in the United States because of the rising rate of cesarean deliveries. Vesicouterine fistulas have various presentations including menouria, hematuria, or urinary incontinence.
  
  
  
  A 39-year-old multiparous woman presented with urine leakage after her third cesarean delivery. She had been treated for mixed urinary incontinence with overactive bladder medications and a midurethral sling with continued complaints of urine leakage. The patient noticed her symptoms of urine leakage improved during menses when she used a menstrual cup. After confirmation of vesicouterine fistula, the patient underwent robotic-assisted surgery and her symptoms of insensible urine leakage resolved.
  
  
  
  When evaluating women with urinary incontinence and a history of cesarean deliveries, use of menstrual cup may aid in the diagnosis of vesicouterine fistula. Robotic-assisted laparoscopic repair with tissue interposition flap is an efficacious minimally invasive method for treatment of vesicouterine fistula.
authors.affiliation: From the *Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; †Division of Urology, Department of Surgery; and ‡Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences.
authors.forename: Leah
authors.initials: L
authors.lastname: Goldberg
authors.forename: Sammy
authors.initials: S
authors.lastname: Elsamra
authors.forename: Juana
authors.initials: J
authors.lastname: Hutchinson-Colas
authors.forename: Saya
authors.initials: S
authors.lastname: Segal
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D057210:Delayed Diagnosis; D005260:Female; D005402:Fistula / Q000175:diagnosis*; D006801:Humans; D015907:Hysteroscopy; D052576:Menstrual Hygiene Products; D001747:Urinary Bladder Fistula / Q000175:diagnosis*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014591:Uterine Diseases / Q000175:diagnosis*