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AJR 2005; 184:139-142
© American Roentgen Ray Society

Original Report

Vesicouterine Fistulas: Imaging Findings in Three Cases

Tarek Smayra1, Michel A. Ghossain1, Jean-Noël Buy2, Maroun Moukarzel3, Denis Jacob4 and Jean-Bernard Truc4

1 Department of Radiology, Hôtel-Dieu de France, Blvd. Alfred Naccache, Achrafieh, PO Box 16-6830, Beirut, Lebanon.
2 Department of Radiology, Hôtel-Dieu de Paris, Cedex 04, Paris 75181, France.
3 Department of Urology, Hôtel-Dieu de France, Beirut, Lebanon.
4 Department of Obstetrics and Gynecology, Hôpital Lariboisière, Cedex 10, Paris 75475, France.

OBJECTIVE. The objective of our report is to present three cases of vesicouterine fistulas secondary to a cesarean delivery, a uterine rupture during labor, and radiation therapy. The delay between the onset of symptoms and the diagnosis varied between 3 and 7 years. Different techniques such as color Doppler sonography, excretory urography, cystography, CT, MRI, cystoscopy, vaginoscopy, and hysterography were performed with variable results, mostly negative and sometimes undefined.

CONCLUSION. The definitive diagnosis was made with contrast-enhanced helical CT after cystography in one case, unenhanced helical CT after hysterography in another case, and cystography in the third case. Vesicouterine fisula rarely is thought of in the differential diagnosis because of its rarity and negative results on radiologic and endoscopic tests. The diagnosis is made on imaging after opacification of the uterus or the bladder depending on the pressure gradient obtained and the location of the fistula in relation to the uterine isthmus.


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