title: Vesicouterine fistula: teaching video on diagnosis and surgical treatment.
abstract: BACKGROUND
  A 42-year-old woman presented with urinary incontinence 9 years after the last of four vaginal deliveries. She had also had one Caesarean section. Immediately after the last delivery, she presented with haematuria, which resolved within a few hours, but the drain remained prophylactically for 7 days. Nine years later, she was referred to a specialist hospital.
  
  
  METHODS
  The patient presented with continuous urinary incontinence, and physical examination revealed a loss of urine from the vagina, the latter confirmed by a methylene blue test showing loss of urine from the uterine cervix. Other diagnostic techniques used were cystography, cystoscopy and uro-CT. Based on a literature review of the management options for such patients and the relevant clinical details of our patient, a decision was made to perform a total abdominal hysterectomy and fistula repair.
  
  
  CONCLUSIONS
  Six months following surgery, the results were entirely satisfactory, with full urinary continence and significant improvement in the patient's quality of life. A discussion about controversial approaches to diagnosis and management is included.
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Marin-Sanchez
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain. marisasanchez@um.es.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Sánchez-Ferrer
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Garrido-Navarro
authors.affiliation: Department of Urology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Prieto-Gonzalez
authors.affiliation: Department of Gynecology and Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Machado-Linde
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D001747:Urinary Bladder Fistula / Q000175:diagnosis / Q000601:surgery*; D014591:Uterine Diseases / Q000175:diagnosis / Q000601:surgery*
keywords: Diagnosis; Surgical technique; Treatment; Vesicouterine fistula repair