Urinary fistula.

Recent advances in the repair of nonobstetric fistulas include a tendency toward earlier repair attempts, use of ureteral stenting and endoscopic correction, and even the use of laparoscopy for fistula repair. There has also been an increased use of posthysterectomy cystoscopy for early identification of ureteral or bladder injury to prevent later fistula. The current initial success rate for repair of obstetric fistulas in developing countries ranges from 65 to 95%. Now that most obstetric fistulas can be repaired surgically, management of previously nonrepairable fistulas and fistula-associated complications has become a greater focus of concern. Efforts are underway to increase community based obstetric training to prevent obstetric fistulas, and a new obstetric fistula classification has been proposed to emphasize the complications mentioned above.