[Short and long-term results of the treatment of vesicovaginal fistula by the vaginal approach (author's transl)].

Gynecologists prefer the vaginal route for closure of vesicovaginal fistulae. Urologists, however, have some doubts as to the long-term results as far as proper function is concerned. The purpose of this investigation was to discover the limits of the vaginal fistula operations with reference to patients at the Department of Gynecology and Obstetrics, University Erlangen-Nürnberg. From 1962 to 1976, 40 women with vesicovaginal, urethrovaginal and vesicocervicovaginal fistulae were treated. Forty-five operations were necessary. In one patient, surgery in two sessions was planned from the beginning. Besides 4 obstetric fistulae, gynecological operations were the original cause of the fistulae in 34 cases. Two women had actinic fistulae (overdosage of intracavitary radium application). Attempts to close the fistulae here failed utterly. The Latzko technique was used in 27 women. Füth's method, in 7. In the remaining cases various vaginal procedures were chosen, for example, interposition of the bulbocavernosus muscle or interposition of the uterus. Three late complecations with recess formation (in 2 cases with concrements) after the Latzko operation could be treated trans-urethrally. Ten years after a Füth's operation one patient had to undergo vaginal surgery for an urethral diverticulum with concrement. The precedure of choice in the typical post-hysterectomy fistula is the Latzko operation. For fistulae patients who still have a uterus, other vaginal procedures are preferable. No attempt should be made to close a radiogenic fistula--usually following inadequate radiation therapy--by a vaginal operation. Details of our indications are fully dealt with in the discussion.