Youssef’s syndrome following caesarean section: a rare case
Youssef’s syndrome is a rare condition characterized by vesicouterine fistula with cyclic haematuria, amenorrhoea and incontinence of urine. A vesicouterine fistula is an abnormal connection between the uterus and bladder that most commonly occur due to inadvertent injury to the bladder during lower segment caesarean section. The following case has been reported in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology.

A 22-year-old Hindu female reported with chief complain of cyclic bleeding per urethra along with urinary incontinence from past 6 month. Patient is lactating and ammenorrhic from past 1- year. Patient was apparently well 6-month back then she complained of pain abdomen with cyclic bleeding per urethra and dribbling of urine per vagina. Patient had two lower segment caesarean section with first caesarean done 3 years back for fetal distress. She underwent second caesarean 1 year back for obstructed labor. Patient gave history of prolong catheterisation of approximately 21 days after second caesarean section.


Healthy pfannesteil scar was there. Noticeable urine smell was there during examination. On per speculum examination, cervix seemed to be healthy. No urine leak seen during the speculum examination. Per vaginal examination seems to be normal. The biochemical, haematological and hormonal investigations were normal. Abdominal sonography done that was suggestive of VUF. Patient planned for hysterocystoscopy under anaesthesia.

The cystoscopy and hysteroscopy suggestive of 2 cm fistulous opening on posterior wall of bladder with irregular congested margins; a guide wire passed through this opening and visualized hysteroscopically through anterior wall of uterus. The endometrium was thin Diagnosis of uterovesical fistula confirmed and patient planned for surgical repair of UVF. Laparotomy done. On per op examination the anterior surface of the uterus seen adherent to the bladder. Bladder dissected away from the uterus.


A band seen between anterior surface of uterus and posterior wall of bladder. Further dissection done, and an opening seen in the posterior wall of bladder and anterior surface of uterus. The fistulous tract excised, and the opening of the uterus closed with vicrly No. 1 suture transversely. The urinary bladder closed in two layers with vicrly No. 2-0.

Omental graft placed between the uterus and bladder. The abdomen closed in layers and per urethral catheter kept in situ for 2 weeks. Injectable antibiotics given for 5 days. Catheter removed on day 14 after proper bladder training. Post-operative period was uneventful and patient discharged on day 15. Patient called for follow up after 4 weeks. Patient has resumed regular menstrual cycles and had no urinary complaints.

Clinical pearls:-
• Although vesicouterine fistula are rare, it should be there in mind if patient present with a history of caesarean along with complain of haematuria and urinary incontinence.

• Identification of the anatomical landmarks and adequate retraction of the bladder during caesarean section helps in preventing these fistulae and its associated problems like psychological upset, social and physical problems

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Dr. K●●●●●●●●●i A●●●●●●●●n and 3 others like this2 shares
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Dr. P●●●l D●●●●h M●●●●●●l
Dr. P●●●l D●●●●h M●●●●●●l Obstetrics and Gynaecology
We have operated two cases of same problems laparoscopically
Jan 3, 2019Like1
Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
Usually a difficult repeat caesarean which is the result of unacceptable primary caesarean section methods is responsible for such disabilities. Thanks to the patient that she has no complaint either against the present surgeon nor against the previous surgeon and thank God things go well when the surgeon proceeds in a routine way. We should be careful in all the steps of primary sections and also avoid unnecessary sections.... Read more
Jan 6, 2019Like1