Urinary diversion in the vesico-vaginal fistula patient: general considerations regarding feasibility, safety, and follow-up.

Some women with vesico-vaginal fistulas (VVF) have injuries so severe that they cannot be repaired in a way that would restore continence. The management of these women has been a source of controversy among the providers of VVF care. It would seem logical that urinary diversion surgery could relieve the suffering endured by women with unrelenting urinary incontinence. However, there is little objective evidence on which to base determinations on the safety and practicality of performing urinary diversion in the desperately poor areas where fistulas occur. As in all other areas of VVF care, more data are required before good treatment choices can be made for patients with inoperable VVFs.