A case of successful management by LH-RH agonist for vesicouterine fistula after cesarean section

Abstract

(Case) A 31-year-old woman noticed lower abdominal pain and urinary incontinence after voiding one month after third cesarean section. Cystoscopy and cystourethrography demonstrated a vesicouterine fistula at the posterior wall of the bladder. She complained of paroxysmal lower abdominal pain and slight incontinence without urge after voiding several times a month, which presented before and after menorrhea. Breast-feeding was ended 1 year after the labor, and then she underwent LH-RH agonist to keep amenorrhea. Urinary incontinence resolved completely within five months of hormonal therapy. During 8 years follow-up, she remains asymptomatic and cystourethrography did not demonstrate the leakage. (Discussion) Most cases of vesicouterine fistula have been managed by surgical repair. As the pathophysiology of this disease resembles endometriosis, less-invasive hormonal therapy using LH-RH agonist can be a good treatment option before surgery.