[Obstetrical urogenital fistulas then and now]

An analysis was made of the aetiology and localisation of 83 obstetric urogenital fistulae, in 15-year intervals, which had been treated at the Gynecological Hospital of Charité over the past 45 years, with the view to finding out, if obstetrics continues to play a causative role in fistulation. With overall figures having stayed nearly constant (31, 25 and 27 fistulae), an increase has been primarily recordable from causes relating to caesarean section and from fistula localisations in the vesico-uterine region. Obstetric causes accounted for 10 per cent and gynaecological causes for 90 per cent of 808 urogenital fistulae throughout the entire period under review. Hence, at least surgical obstetrics should not even today be underestimated as a cause of fistulation. These findings have given rise to considerations of strategy and to conclusions regarding prophylaxis against fistulation with particular reference to caesarean section.