Based on about 100 urogenital fistulae the various urologic aspects are discussed. The great role of urologic surgery, especially operations for prolapse, is evident in the pathogenesis of fistulae. Loop-operations with foreign substances is dangerous, as is endoresection in girls. We agree with gynecologists that fistulae are best operated vaginally. Vesicouterine fistulae and those starting in contracted bladders form exceptions. The IVP is necessary in dealing with fistulae at the trigone and bladder neck. Hydronephrosis is an indication for ureteral reimplantation. Failures occur practically exclusively at closure of the bladder neck fistulae. Secondary (or simulataneous?) suspension is obligatory here. Urethral fistulae seldom lead to incontinence. If incontinence appears, one must think of a complicated bladder neck insufficiency. The suspension here is of greater significance than the fistular closure. Substitution of the totally destroyed urethra is possible in many ways, yet functional result is meagre. In reconstructive surgery of bladder neck and urethra the artificial vesicovaginal fistula is a good diversionary means. Definitive diversions are seldom necessary.

Keywords:
Fistula, vesico-vaginal, Fistula, urethro-vaginal, Fistula, urogenital
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© 1971 S. Karger AG, Basel
1971
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