Transvesical and transvaginal reparation in urinary vaginal fistulas

Thirty-two cases of urinary vaginal fistulas treated surgically at our Department between 1985 and 1991 have been reviewed retrospectively. There were 26 cases of vesicovaginal fistulas, 1 case of urethrovaginal fistula and 5 cases of ureterovaginal fistulas. Gynaecological surgery was the leading cause of the fistulas (24/32). Eight cases of vesicovaginal fistulas and 1 case of urethrovaginal fistula were repaired transvaginally, with 88.8 per cent success. Seventeen cases of vesicovaginal fistulas were repaired by suprapubic transvesical approach, with 88 per cent success at the first attempt and 94 per cent success at 2 attempts. One patient with vesicovaginal fistula underwent ureterosigmoidostomy. Ureterovaginal fistulas were repaired successfully by simple ureteroneocystostomy in 4 cases and 1 case of ureterovaginal fistula required ureteric substitution with a Boari bladder flap.