[Special treatment conditions in obstetric urogenital fistulas]

Reported in this paper is treatment of two African women for fistulae and incontinence. Findings recorded from one of them included total defect of the urethra and anterior wall of the rectum, including anus, as well as two vesicovaginal fistulae. Four operations were performed on her within 16 months, with sigmoid preternatural anus, hysterectomy, and restoration of vesical integrity being the only possible ways to remedy. Attempts for restoration of the urethra failed. Her absolute urinary incontinence was improved to stress-dependent incontinence. - A large vesicocervical-vaginal fistula was recorded from the other patient on whom combined abdominovaginal hysterectomy and fistuloplasty as well as dura-sling operation were performed in three sessions, in the course of nine months. These were supplemented with an operation to lengthen the urethra. The two former approaches were successful in removing absolute incontinence, while the patient's functional urinary incontinence was cured by the two latter approaches. Some considerations of principle are derived from the two cases with regard to choice of methods and actual treatment.