[Treatment of vesicovaginal fistulas]

The authors evaluated in a retrospective analysis their experience with treatment of vesicovaginal fistulae in 36 patients. Most frequently--almost in 90%--the fistulae developed after a gynaecological operation, in particular surgery on account of benign, but also malignant disease. The authors used for surgical correction of the fistulae a transvaginal approach in 28 (77.8%) patients, a transvesical approach in 5 (13.9%) patients and a transvesical and transperitoneal approach in two (5.5%) patients. One fistula receded spontaneously during drainage of the urinary bladder. Primary correction of the fistula was successful in 34 (94.4%) patients. In two patients further surgical treatment was necessary. With regard to their favourable experience the authors recommend a transvaginal approach which is in their opinion suited for the majority of non- complicated vesicovaginal fistulae. In corrections of extensive fistulae after radiotherapy a combined transvesical and transperitoneal approach with fixation of the omentum in the space between the vagina and urinary bladder proved useful.