Management of unrepairable urinary vaginal fistulae in a developing country

Thirty-eight out of 44 patients with unrepairable urinary and rectal vaginal fistulae obtained good to excellent results from diverting the urine by uretero-colic anastomosis. The patients who hitherto were regarded as social outcasts became integrated into society once again. Intestinal conduits are generally not employed for urinary diversion, because of the social dislike for colostomies and ileostomies, coupled with the lack of availability of the necessary external appliances, in Nigeria. In spite of the good results recorded, it is felt that urinary diversion by uretero-colic anastomosis for vesico-vaginal fistulae should be regarded as the last resort; there are well-known adverse complications from the operation, coupled with psychological trauma to the patients because of their inability to micturate in the normal fashion.