Cyclic Hematuria Misdiagnosed as Hemorrhagic Cystitis in a Rare Case of Vesicouterine Fistula Post Cesarean Section: A Case Report of Youssef Syndrome

Abstract

Vesicouterine fistulas are rare complications that may occur following cesarean sections and are frequently misdiagnosed due to their diverse clinical presentations. This report presents a case involving a small vesicouterine fistula initially managed conservatively, which later manifested as cyclic hematuria mimicking hemorrhagic cystitis, ultimately leading to a diagnosis of Youssef syndrome. A 45-year-old woman developed persistent vaginal urinary leakage 3 weeks after a cesarean section. Diagnostic evaluation confirmed a small (<1 cm) vesicouterine fistula. Conservative management with Foley catheterization resulted in spontaneous closure. Four months later, the patient experienced cyclic gross hematuria and dysuria without menstruation, and was subsequently diagnosed with Youssef syndrome. Hormonal therapy using continuous oral contraceptives successfully resolved the hematuria, providing a noninvasive therapeutic option. This case highlights the importance of considering Youssef syndrome in patients with cyclic hematuria after cesarean section, in order to distinguish it from hemorrhagic cystitis and ensure timely, appropriate management.