Surgical repair of post‐cesarean vesicouterine fistula: A systematic review and a plea for prevention

Abstract

AbstractBackgroundVesicouterine fistula (VUF) is a iatrogenic injury in the vast majority of cases. The worldwide increase of cesarean delivery rates is expected to lead to increased complications.ObjectivesTo assess current evidence on VUF pathogenesis and surgical management.Search StrategyPubmed and Embase databases were searched from January 2000 to January 2023 using relevant key words.Selection CriteriaOnly original articles including either transabdominal or transvaginal surgical routes for post‐cesarean VUF repair, in English language, were included.Data Collection and AnalysisTwo authors independently screened the references for eligibility, data extraction, and assessment of methodologic quality. All available surgical outcomes were recorded.Main ResultsOf the 1160 studies retrieved, 67 were selected for analysis. Most of these were case reports, case series, or observational cohort studies including a total of 284 patients. The majority (78.6%) of patients had more than one cesarean section, and approximately 10% of them experienced an overt bladder injury and/or uterine rupture at the time of cesarean delivery. The supratrigonal part of the bladder was most commonly involved (92.5%). The majority of patients (88.8%) underwent delayed VUF repair through laparotomy. Length of stay and blood loss were significantly less in patients treated via a minimally invasive approach (P < 0.001 and P = 0.02, respectively). Most patients had double‐layer bladder repair and single‐layer uterine repair. The overall success rate was 100% on first attempt for each independent combination of different surgical approaches and techniques. Live birth following VUF repair was reported in 23 patients.ConclusionsPaying close attention to surgical details is crucial to reduce the incidence of this complication and recurrence rates. Double‐layer bladder closure and delayed timing of repair of VUF are recommended.