經尿道膀胱子宮廔管修補

陳昭安¹、王百孚¹、陳柏華¹

彰化基督教醫院外科部泌尿科¹

Transurethral intravesical cystorrhaphy for complicated vesicouterine fistula

Chao-An Chen¹, Bai-Fu Wang¹, Pao-Hwa Chen¹

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan;

Purpose: To present our experience of transurethral intravesical repair of vesicouterine fistula

Case presentation: A 36-year-old woman with the history of ovarian endometrioma with spontaneous rupture with pelvic adhesion had pregnancy at 38+4 weeks with malpresentation in labor and membrane rupture with fetal presenting through the vagina. Emergent cesarean section was performed. Increased lochia and foul-smelling discharge was noted. She was send to our ER where elevated white count and increased heart rate was noted. CT showed fluid accumulation in uterus and pelvic hematoma was noted. Cystoscopy showed a perforation at posterior wall of urinary bladder with leakage from vagina. Bladder sono and cystography showed dislocated Foley’s catheter in uterus with leakage of contrast medium outside the bladder with contrast extravasation. Transurethral intravesical repair of bladder perforation was perforemd.

Results: This patient has had successful resolution of her vesicouterine fistula after undergoing transurethral repair.

Conclusions: Transurethral intravesical cystorrhaphy is a safe and effective option for vesicouterine fistula in experienced hands.