Spontaneous abortion through the bladder.

Amenorrhea, menouria (cyclical hematuria) and absence of urinary incontinence that characterize the Youssef’s syndrome [1] is the common presentation of vesicouterine fistula. Women with vesicouterine fistulas are generally considered to be sterile [2]. Para 1 who presented with massive hematuria to emergency ward, posed a diagnostic dilemma. She had undergone emergency cesarean section for malpresentation 18 months ago; indwelling urinary catheter was kept for 8 postoperative days and had not resumed her menstruation after the cesarean. She denied any attempt at uterine curettage. There was no history of urinary incontinence. On examination, there was minimal vaginal bleeding. Cervical os was open and bits of fleshy tissue were obtained through the os during examination. Trans-abdominal ultrasound showed