Six years after caesarean section due to obstructed labour, the 37-year-old woman complained about involuntary loss of urine and haematuria during menstruation. During the course of the subsequent pregnancy the urinary incontinence deteriorated. A vesico-uterine fistula was diagnosed in the 24th week of gestation by transvaginal ultrasound (Fig. 1, marked with white arrows). Gynaecological examination revealed loss of urine through the cervix. Urethrocystoscopically, a 1 cm fistula was confirmed in the posterior bladder wall. At 37 weeks of gestation, a healthy girl was delivered by caesarean section and fistula closure was performed simultaneously. The diameter of the fistula had extended continuously to 3 cm at delivery (Fig. 2, marked with black arrow). A two-layer tension-free closure of the bladder wall and an one layer closure of the cervical wall were performed using a biologic graft interposition between bladder and cervical wall. Since removal of the suprapubic catheter 3 weeks postoperatively, the patient remained continent.

Fig. 1
figure 1

Vesico-uterine fistula in pregnancy, 24th week of gestation (marked with white arrows)

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Fig. 2
figure 2

Vesico-uterine fistula in the posterior bladder wall, 37th week of gestation (marked with black arrow)

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