Difficult obstetric vesicovaginal fistula: a report on 12 cases.

In each of the 12 cases presented, the fistula was the result of obstructed labor. Common features to each case were: (a) a large retropubic defect involving the anterior vaginal wall, bladder and urethra, (b) total or partial urethral rupture, and (c) marked vaginal wall scarring with vaginal stenosis. Primary repair was performed by the vaginal route, and two patients were cured by the first operation. Six patients required two or more vaginal procedures for successful closure. Following repeated failure of vaginal closure, two patients had a successful transvesical closure and two require ureterosigmoidostomy.