[Complex vesicovaginal fistulas]

The author reviews the therapeutic indications (it being necessary to abstain from repair of certain fistulae) in vesico-vaginal fistulae. Fistulae following pelvic irradiation, african fistulae of obstetric origin and the various difficulties (and their possible solutions) which may arise when the fistula passes through an extensive zone of fibrous tissue, is close to a ureteric orifice, at the neck of the bladder or associated with a loss of the urethra or with a recto-vaginal fistula, are studied. In the opinion of the author, classification between simple and complex vesico-vaginal fistula corresponds better to reality than the historical classification into high and low fistulae. The preferred surgical approach remains vagino-perineal. Finally, the complexity of the lesions may require combination of a surgical stage via a superior approach with the essential surgical stage which even today must be performed by an inferior approach.