Urovaginal fistulae: 20 years' experience

During the last 20 years we treated 86 patients suffering from urovaginal fistulae. The highest incidence of fistulae occurred in the third and fourth decades of life (31 and 28 patients, respectively). The incidence was very low after the age of 50 (only 2 patients). Fistulae were either simple between the bladder and vagina (54 cases), urethra and vagina (13 cases) and ureter and vagina (7 cases) or complex connecting more than two organs in 12 cases. The causative trauma was difficult prolonged labour with trial forceps in 28 patients. Fistulae followed caesarean section with or without hysterectomy in 24 women. Hysterectomy, whether abdominal or vaginal, was followed by fistulae in 19 cases. Five cases refused operation and 1 was medically unfit. Ureterovaginal fistulae were successfully treated with ureteroneocystostomy. Vesicovaginal fistulae were met with in 54 cases (3 cases required diversion, 1 was medically unfit and 46 were successfully repaired and 4 failed). Simple repair was performed in 30 cases, repair and flap interposition in 12, ileocystoplasty in 7 and colocystoplasty in 1. Urethral fistulae were reported in 13 cases (simple repair in 11 cases and neourethra in 2), of these, 10 were successfully corrected. Complex fistulae were diagnosed in 12 cases (3 required diversion, 5 refused operation, 2 successfully repaired and 2 unsuccessfully corrected). The 2 successfully repaired case were 1 ureterovisicovaginal (treated with ileocystoplasty) and 1 cervicovesicovaginal (treated with repair and flap interposition). The 2 failures were ureterovesicovaginal and treated with simple repair.