Wednesday, May 2, 2012

Cystographic Images of Youssef Syndrome: Flower on Top of the Bladder

A 38-year-old woman presented with continuous urinary incontinence (for the last 13 years) after obstructed labor and vaginal delivery of full-term stillborn neonate. Investigations revealed normal renal functions; intravenous urogram revealed normal upper tracts and small capacity bladder (Fig. 1).
Figure 1    Intravenous urography showing bilateral normal kidneys and small capacity bladder (can also be caused by inadequate filling of bladder as a result of fistula). 

 Cystogram with a Foley catheter revealed small-capacity bladder with bilateral grade II vesicoureteral reflux and, incidentally, also showed reflux into the uterus (Fig. 2). Cystoscopy showed a vesicovaginal fistula at the bladder neck, small-capacity bladder, and another opening above the left ureteral orifice that was found communicating with the uterine cervix. Because of the complexity, continent urinary diversion was performed.
Figure 2    Cystogram with Foley catheter showed bilateral grade II vesicoureteral reflux, small capacity bladder, and contrast flowing into the uterus (“flower pot” appearance). 
Urology - Volume 79, Issue 5 (May 2012)  



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