A new retropubic retrourethral approach for large vesico-urethrovaginal fistulas.

Of all types of vesicovaginal fistula those affecting the trigone and bladder neck, and associated with urethral loss are the most difficult to repair. For these cases a retropubic retrourethral procedure is presented that offers a direct approach to close the vagina. A urethrovesical flap tube also can be fashioned to form a continent neourethra. Urodynamic studies showed that the proximal vesical and distal urethral components of the neourethra contribute to sphincteric function.