Urethrovaginal and vesicovaginal fistula. A review of 29 patients.

During an 11-year period 29 women were treated for 6 urethrovaginal and 24 vesicovaginal fistulae. In all patients the urethrovaginal fistula was preceded by an operation for a benign lesion. Of the 24 patients with vesicovaginal fistulae 11 had a benign and 13 a malignant primary disease. Endoscopy, vaginal examination and IVP provided in most cases sufficient information with which to establish a diagnosis. The urethrovaginal fistulae were operated on either by a vaginal approach (3 patients); two recurrences occurred but healed after reoperation. Of the 24 patients with vesicovaginal fistulae, 14 underwent a combined operation usually including omentum interposition, while 10 underwent primary diversion. Primary cure ensued after 9 of 14 combined operations; recurrences were operated on by a combined approach in 2 patients, vaginal in one and with fibrin occlusion in one. Eight of the 10 patients who underwent urinary diversion had a malignant disease. A vaginal approach in recommended at the primary reconstruction of urethrovaginal fistulae, whereas a combined suprapubic and vaginal approach is recommended in vesicovaginal fistulae as well as in recurrent urethrovaginal fistulae.