UROVAGINAL FISTULAS - 20 YEARS EXPERIENCE

During the last 20 years we treated 86 patients suffering from urovagi nal fistulae. The highest incidence of fistulae occurred in the third and fourth decades of life (31 and 28 patients, respectively). The inc idence was very low after the age of 50 (only 2 patients). Fistulae we re either simple between the bladder and vagina (54 cases), urethra an d vagina (13 cases) and ureter and vagina (7 cases) or complex connect ing more than two organs in 12 cases. The causative trauma was difficu lt prolonged labour with trial forceps in 28 patients. Fistulae follow ed caesarean section with or without hysterectomy in 24 women. Hystere ctomy, whether abdominal or vaginal, was followed by fistulae in 19 ca ses. Five cases refused operation and 1 was medically unfit. Ureterova ginal fistulae were successfully treated with ureteroneocystostomy. Ve sicovaginal fistulae were met with in 54 cases (3 cases required diver sion, 1 was medically unfit and 46 were successfully repaired and 4 fa iled). Simple repair was performed in 30 cases, repair and flap interp osition in 12, ileocystoplasty in 7 and colocystoplasty in 1. Urethral fistulae were reported in 13 cases (simple repair in 11 cases and neo urethra in 2), of these, 10 were successfully corrected. Complex fistu lae were diagnosed in 12 cases (3 required diversion, 5 refused operat ion, 2 successfully repaired and 2 unsuccessfully corrected). The 2 su ccessfully repaired cases were 1 ureterovesicovaginal (treated with il eocystoplasty) and 1 cervicovesicovaginal (treated with repair and fla p interposition). The 2 failures were ureterovesicovaginal and treated with simple repair.