[Experiences with bladder-uterus fistulae]

The present summary reports 5 cases of vesicocervical fistula, 9 cases of vesicocervico-vaginal fistula and 1 of vesicocervicocorporeal fistula seen over the last 20 years. When compared with the period between 1941 and 1955 the number of such fistula cases has increased fourfold. All thses fistulas, with just one exception, arose as a consequence of obstetric treatment. Conservative therapie was successful only in one case while all the other fistulas had to been operated upon. The preferred operating technique was that of vaginal metroplasty (Wolkowitsch-Küstner's technique). Hysterectomy or stump exstirpation with cystorraphy were performed in 4 cases. The combined vesicocervico-corporeal fistula required a vaginoabdominal treatment. 14 patients were brought to recovery. Increases in the number of vesicouterine fistulas as observed over recent years are considered to be related to a more concentrated therapy and to a higher frequency of cesarean sections. The vaginal route is all the more justified for fistula operations the nearer the fistula is located to the vagina. Operations of that kind require adequate skill in urinary bladder-ureteral- and uterosurgery.