Abstract
A vesicovaginal fistula is one of the most distressing mishaps that can befall a woman. Recently three cases of the disease were experienced in our clinic and were successfully treated with surgery.
Etiology:
1. Congenital
2. Severe inflammatory disease of the bladder
3. Gynecological and urological surgery: the most common cause of the disease
4. Cancer of the vagina, bladder, or, most frequently the cervix, with necrosis of the tissue or following radiation therapy
Eight cases experienced in our clinic were: one tuberculosis, five gynecological surgery and two cancer.
Symptom and diagnosis:
Urinary incontinence through the vagina is the chief complaint.
The vaginal orifice will be usually found with urine leaking through it by the vaginal speculum, and vesical opening may be discovered cystoscopically. A very small orifice may be found with aid of retrograde or excretory cystography.
Treatment:
1. Indwelling urethral catheter drainage: a small fistula surrounded by healthy tissue
2. Surgical repair: the most common treatment For successful surgical repair, we would especially stress the following principal points:
1. Denudation of the fistulous tract
2. Separation of the bladder wall from that of the vagina so wide as to permit closure of the openings in both bladder and vagina without tension
3. Drainage of the bloodclots
4. Diversion of the urinary stream during the entire period of healing
