VESICOVAGINAL FISTULA

Abstract

1). Our experiences and results at Tokyo Teishin Hospital, with patients who had operations for the vesicovaginal fistulas are reported.
In this series of 20 patients there were 13 vesicovaginal, 3 vesicovaginorectal, 2 vesicocervicovaginal and 2 urethrovesicovaginal fistulas.
These fistulas have been divided from their etiological factors into five groups. The cases and the results of surgical treatment were as follows.
NO. OF PER CENT. MORTALITY
CAUSES OF FISTULAS PATIENTS CURED PERCENT
(1) Obstetric……5……100.0……0
(2) Abdominal operation of uterus for non-malignant diseases……3……100.0……0
(3) Abdominal hysterectomy for cancer of the cervix……5……80.0……0
(4) Irradiation therapy for cancer of the cervix……6……50.0……0
(5) Resection of the bladder neck for neurogenic bladder……1……0.0……0
All of cured cases were performed by transvesical approach.
2) As indicated in next table, the obstetric fistulas were the most frequent in our country. But the last ten years, these incidence have been decreased remarkably concomitant with increasing caesarean section.
THE CAUSES OF VESICOVAGINAL FISTULAS IN JAPAN: 1903-1966
PATHOGENESES NO. OF CASES PER CENT
(1) Obstetric……115……44.1
(2) Gynecologic……104……40.6
(3) Tuberculous……16……6.1
(4) Calculi or foreign body in the urinary bladder……5……1.9
(5) Vesical operation……4……1.5
(6) Traumatic……4……1.5
(7) Miscellaneous……7……2.7
(8) Unknown etiology……6……2.0
3) After a review of 105 cured cases in Japanese literatures and our experiences, we believe that the most effective approach to vesicovaginal fistula is as follows.
LOCATION OF FISTULA ROUTE OF CHOICE
(1) Near the vesical neck……vaginal
(2) In the trigone……vaginal or transvesical
(3) Near the ureteral orifice……transvesical
(4) In the posterior wall of bladder……transvesical