Surgical treatment of urinary fistulae

A survey is presented, based upon a personal material of 225 cases of urinary fistulae. 173 of them were postoperative or obstetric fistulae, whereas 52 had appeared after a radiological or combined radiological and surgical treatment for cancer of the uterus. --The author's method for preparing the fistula region from a transverse incision under the external urethral orifice is described as well as his grafting techniques. Vessels are brought to the fistula region by using flaps from one or both pubococcygeus muscles, the rectus abdominis muscle or the gracilis muscle. --For vesico-vaginal fistulae situated high up in the fundus a graft from the omentum majus or an appendix epiploica is sometimes used. They can usually be grasped from below after the peritoneum has been opened. --In cases where the ureters were also damaged by irradiation a special technique was used. After the damaged part of the ureter had been resected the ureters were implanted into an ileum segment which was anastomosed to the bladder fistula. --In one of the 173 non-irradiated cases, a Bricker-bladder had finally to be made because of the failure to achieve a functioning urethra. The others were all cured after one or in a few cases two operations. --Among the 52 cases, which had been irradiated, 46 coud to be made, one got a fast growing local recurrence of the carcinoma and one had too bad general condition to allow a diversion operation. Two patients have rest fistulae but may be possible to cure conservatively.