A 30-year-old woman presents 4 months after a lower segment cesarean section with amenorrhea and recurrent painless gross hematuria appearing precisely with each menstrual period. Voiding is otherwise normal and there is no vaginal leakage. The most likely diagnosis is:

• A Vesicovaginal fistula
• B Youssef syndrome (vesicouterine fistula) ✓
• C Endometriosis of the bladder wall
• D Ureterovaginal fistula

Explanation

Youssef syndrome is a vesicouterine fistula, typically following cesarean section, presenting with the triad of menouria (cyclical hematuria during menstruation), amenorrhea, and absence of urinary incontinence because menstrual blood drains into the bladder instead of the occluded cervical canal. A vesicovaginal fistula would cause continuous urinary leakage per vaginam, and a ureterovaginal fistula causes constant dribbling unrelated to the cycle. Diagnosis is confirmed by cystoscopy or CT cystography.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.