This case report highlights Youssef Syndrome in a 36-year-old woman presenting with five years of cyclic hematuria and oligomenorrhea following multiple Cesarean sections and uterine rupture. In a resource-limited setting lacking MRI or cystoscopy, a clinical diagnosis of vesico-uterine fistula (VUF) was confirmed using a 3-swab test with methylene blue. Intraoperative findings during laparotomy revealed a 5 mm fistula with extensive adhesions. Successful treatment involved adhesiolysis and fistulorrhaphy, resulting in complete symptom resolution. The case demonstrates that clinical suspicion and bedside tests are vital diagnostic tools when advanced imaging is unavailable. • VUF diagnosis is challenging in low-resource settings lacking advanced imaging. • VUF can clinical present as Youssef Syndrome. • The 3-swab test may be helpful for VUF diagnosis where imaging is absent. • Laparotomy gives better access for exploration and fistulorrhaphy. • 14-day postoperative bladder catheter is contributive for better outcome.
Munyanderu et al. (2026) studied this question.