URETEROVESICOVAGINAL FISTULAS

Our experience with urogenital fistulas are reviewed and three instanc es of complex ureterovesicovaginal fistulas, which can be mistaken for pure vesicovaginal fistulas because of diagnostic difficulties, are p resented. If the ureterovaginal component of these fistulas is overloo ked intraoperatively, urinary leakage will persist despite otherwise s uccessful closure of the vesicovaginal component of the fistula. Becau se of the involvement of the terminal ureter in the fistulous system, operative therapy must combine the closure of the vesicovaginal fistul a with reimplantation of the ureter into the bladder and interposition of omentum or a peritoneal patch between the bladder and vagina. Diag nosis and therapy are illustrated by patient reports and literature re view.