Vesico-Uterine Fistula – Hysterosalpingography
HSG
Vesico-uterine fistula is an abnormal communication between the uterine cavity and the urinary bladder, most commonly occurring as a complication of lower-segment cesarean section. On hysterosalpingography (HSG), contrast injected into the uterine cavity is seen directly opacifying the urinary bladder.
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Findings: Uterine cavity outline may be normal or mildly irregular. Early opacification of the urinary bladder is seen without passage of contrast through the fallopian tubes.
Conclusion: HSG features are diagnostic of vesico-uterine fistula.
Patient Symptoms
Patients may present with cyclic hematuria (menouria), secondary infertility, amenorrhea, urinary tract infections, or a history of recent cesarean section.
Procedure (Hysterosalpingography)
HSG is performed during the early proliferative phase of the menstrual cycle. Contrast is injected slowly under fluoroscopic guidance to avoid excessive pressure.
Contrast Medium & Administration
A water-soluble iodinated contrast such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. Approximately 5–8 mL is injected in the lithotomy position.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Leech–Wilkinson cannula
- Rubin cannula
- Balloon HSG catheter
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
High injection pressure should be avoided to prevent enlargement of the fistulous tract. Active infection is a contraindication.
Related Conditions
Differential diagnoses include vesico-vaginal fistula, uterine fistula, post-cesarean scar defect (isthmocele), and bladder injury. Correlation with cystography, ultrasound, or MRI may be required.
Declaration
This case is presented for academic and educational purposes only. Patient confidentiality has been maintained.
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