Surgical management of urethrovaginal and vesicovaginal fistulas.
This report reviews a 50 year period during which 157 vesico- and 24 urethrovaginal fistulas were managed. Although the etiologic factors have changed, there has not been a dramatic decrease in the incidence of this complication. In the last 17 years we have noted an increased number of both types of fistula, primarily related to the increased frequency of gynecologic operative procedures. Only 11 (6%) of the fistulas reported in this series resulted from surgical procedures performed in our department. In this series 96% were repaired vaginally but the abdominal approach was used for certain complicated fistulas. Our initial cure rate was 89% and the final success rate in 157 vesicovaginal fistulas was 94.3%. The urethrovaginal fistulas represent a special problem because of the location, scarring, and lack of sufficient fascia for a second-layer closure. In such instances we have successfully used the bulbocavernous fat pad. The success rate for 24 patients with this type of fistula was 87.5%.