Naila Tahir, Bushra Afzal, Salma Kayani.
Vesico – uterine fistula – a complication of Cesarean section.
Pak Armed Forces Med J Jan ;57(3):230-2.

A 36 years old lady, para 2, both delivered by caesarean section, presented with complaints of dribbling of urine on coughing for last 12 years, menorrhagia and pressure perineum for last 02 years. Local examination revealed normal perineum with a slight clear fluid at introitus. Cough impulse did not reveal urine leak from urethra so possibility of stress incontinence was exclude. Speculum examination revealed intact vaginal walls and clear fluid escaping from cervical os. Cystogram confirmed vesico – uterine fistula. Cystoscopy revealed fistula located in centre above ureter oifices. Intravenous urogram revealed normal study. Ultrasonography revealed 12 weeks size enlarged uterus due to intra – mural fibroid. Abdominal hysterectomy with repair of fistula was planned after couple counselling.

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