URETEROVAGINAL FISTULAS - REPORT OF 45 CASES

The authors report a series of 45 cases of ureterovaginal fistula (UVF ) observed over a 25-year period. The patients had a mean age of 34 ye ars (20 to 50 years). 32 UVF (71%) were secondary to obstetric procedu res and operations and 13 UVF (29%) were due to hysterectomy for gynae cological diseases. The clinical features were dominated by urine leak via the vagina with persistent micturition (68.8%) and low back pain (40%). UVF was associated with vesicovaginal fistula in II patients an d acute renal failure was observed in 4 patients. IVU confirmed the di agnosis in 36 patients (87%) and revealed 23 cases of uretero-hydronep hrosis and 4 silent kidneys. Retrograde ureteropyelography, performed in 4 cases, confirmed the diagnosis of UVF. The lesion was situated on the right side in 26 patients and was bilateral in the other 3 patien ts. The commonest lesion was section (48.8%). Treatment consisted of u reterovesical reimplantation (27 cases), Boari-Kuss bladder flap of (3 cases), psoas bladder (5 cases), nephrectomy (2 cases), end-to-end an astomosis (2 cases), appendico-ureteroplasty (2 cases),;double J stent (2 cases) and ileoureteroplasty (1 case). The course was favourable i n 35 patients (77%).