Author(s): Makama BS, Stephen Y, Liman H and Mienda I

Abstract: The process leading to diagnosis starts with active inquiry into the origin and the evaluation of the presenting problem; known as history taking, the clinician takes his time to inquire about the problem of the patient from its onset and gradually walk himself through the course of the problem with the possible causes in mind. Thus, history taking forms the backbone of every diagnosis. Two patients came to our facility with two different presentations; urinary incontinence and total hematuria but share a similarity on onset of the problem; both patients had uterine surgery each about a week or two from the onset of the presenting complain.First patient is a 40 years old house wife who presents with pain during micturition and total hematuria which began two weeks after she had a myomectomy, the pain was described as dull aching not radiating nor referred, no associated suprapubic pain, no lower urinary obstructive or irritation symptoms, no history of trauma to the abdomen, no passage of stone in urine and no previous history of similar occurrence in the past, no history of weight loss or anorexia and she is not a known hypertensive or diabetic. All possible causes of hematuria were considered and ruled out. On diagnostic Urethrocystoscopy a point of communication was noticed at the posterior wall of the bladder with seepage of menstrual blood from the uterus into the bladder.Second patient is a 35-year old para 9 + 1 patient who had delivery by caesarian section about 3 weeks prior to presentation after which she noticed leakage of urine per vaginum. She has had previous delivery by caesarian section on her 8th pregnancy and had a trial of delivery after a caesarian section (VBAC) which failed due to malposition and cephalopelvic disproportion (CPD) and this necessitated the emergency caesarian section which she had prior to the onset of the presenting complain. She was being evaluated for vesicovaginal fistula (VVF), but on speculum examination urine was notice to seep from the cervical Os. Urethrocystoscopy and perineal examination with dye in the bladder shows a communication at the posterior lateral wall of the bladder with seepage of urine into the uterus from the bladder.These are two cases each with a previous history of a uterine surgery prior to the onset of the presenting complain with no any other identifiable possible cause of the presentation, each needed a urethrocystoscopy to identify a vesicouterine fistula. The direction of flow between the two organs connected by the fistula depended on the intra cavity pressure and the site of the fistula.

DOI: 10.22271/27080056.2022.v4.i1a.47

Pages: 21-23 | Views: 629 | Downloads: 249

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