Cystographic images of Youssef syndrome: flower on top of the bladder

Vesicouterine fistula after obstructed labor is very rare. Hysterosalpingography is the investigation of choice. Cystography primarily does not demonstrate the fistula because the intrauterine pressures are higher than the vesical pressure. A 38-year-old woman presented to us with vecisovaginal fistula and vesicouterine fistula that had developed 13 years earlier after obstructed labor and vaginal delivery of a stillborn neonate. She was found to have normal renal function, but she had developed small capacity bladder and the cystogram performed with Foley catheter showed contrast spilling into the uterus. She was managed by continent urinary diversion.