Management of Urinary-Vaginal Fistula

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Abstract
Two hundred sixty-two patients with urinary-vaginal fistulas were operated on at the Mayo Clinic during 1951 through 1960. A review of these cases indicates that complete investigation of the urinary tract should precede repair, since these abnormal communications appear in many varieties and may be multiple. Anatomic as well as etiologic considerations are important in diagnosis. The abdominal hysterectomy immediately preceded formation of fistula in 153 cases. Preventive measures are discussed. After complete preoperative evaluation of the patient, repair may be effected utilizing two major principles: (1) preservation of blood supply and (2) accurate tissue approximation. Unobstructed postoperative urinary catheter drainage is of primary importance. In the present series, successful surgical correction of vaginal-urinary fistula was affected at first attempt in 88.2% of cases; after reoperations on some, the eventual success was 95.0%.

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