Minimally Invasive Fat Tissue Injection Heals Bladder-Uterus Fistula

Woman Avoids Major Surgery After Cesarean Complication

A vesicouterine fistula is an abnormal connection between the bladder and uterus. This rare condition affects roughly one to four percent of women with genitourinary fistulas. It most commonly occurs after cesarean section deliveries. Traditional treatment typically requires open surgery, which carries a risk of hysterectomy. This case report describes a new approach using processed fat tissue from the patient's own body.

Patient Developed Fistula After Her Fifth Cesarean Section

A 35-year-old woman experienced complications following an emergency cesarean delivery. This was her fifth cesarean section, making the surgery more complex. Three weeks after discharge, she returned with urine leaking from her vagina. She also had a urinary tract infection. Imaging tests confirmed a one-centimeter fistula connecting her bladder to her uterus.

Conservative Treatment Reduced But Did Not Close the Fistula

Doctors first tried a conservative approach by placing a catheter for three months. This helped reduce the size of the fistula but did not fully heal it. The patient refused traditional open surgery, which could have resulted in losing her uterus. Instead, doctors offered a minimally invasive option using Lipogems® technology.

Procedure Harvested and Processed Fat from Patient's Thighs

The treatment involved several steps performed under local anesthesia:

• Fat collection: Doctors harvested fat tissue from both thighs using a gentle suction technique

• Processing: The fat was placed in the Lipogems® device, which breaks it into tiny clusters while removing inflammatory substances

• Fistula preparation: Using a camera through the bladder, surgeons trimmed away unhealthy tissue at the fistula edges

• Injection: The processed fat tissue was injected into the bladder wall around the fistula site

The entire procedure was completed through the urethra and small thigh incisions. No abdominal surgery was required.

Complete Healing Confirmed at Three-Month Follow-Up

The patient went home just one day after the procedure. At three months, doctors performed a cystoscopy (camera examination of the bladder). They found only scar tissue where the fistula had been. A cystogram (special X-ray of the bladder) confirmed complete closure. The patient had no symptoms of urine leakage.

No Recurrence After Two Years of Monitoring

The most encouraging finding was long-term success. At 24 months after treatment, the fistula had not returned. The patient remained symptom-free with normal bladder function. This suggests the repair was durable and the tissue healed properly.

What This Means for Patients with Similar Conditions

This case demonstrates several important points for women facing vesicouterine fistulas:

• Minimally invasive option: This approach avoids large incisions and lengthy hospital stays

• Uterus preservation: Unlike traditional surgery, this method does not risk hysterectomy

• Uses your own tissue: The fat comes from your body, reducing rejection concerns

• Quick recovery: The patient left the hospital the next day

• Lasting results: The repair held for at least two years

The authors note this technique works best for smaller fistulas (under one centimeter) that haven't responded to catheter treatment alone. The processed fat tissue acts like a natural patch, providing both physical coverage and regenerative signals that help the tissue heal.

This represents a single patient's experience, not a large clinical trial. However, it offers hope for women seeking alternatives to major reconstructive surgery. The combination of removing unhealthy tissue and injecting regenerative fat tissue addresses both the structural problem and supports natural healing.

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Source: Spinelli et al., Turkish Journal of Urology, 2020.