[Treatment of vesicovaginal fistula, simple or complicated by urethral destruction. Experience apropos of 903 cases].

The authors review 903 cases of vesicovaginal fistulae, either simple or complicated by ureteral destruction, which were gathered over 21 years. They firstly sum up their classification for the various types of fistulae and/or ureteral destruction. This classification is used as a base for the indications of the various methods of treatment. In uncomplicated vesicovaginal fistulae, healing is obtained in 96.8% of all cases, most often through a vaginal approach. Radiation and repeated recurrence account for most failures. Out of the 82 cases of ureteral destruction, only degrees I, II and III are amenable to reconstruction. This is associated to normal continence in 56% of all cases, owing to the systematic use of autosphincterotomy, for which the technique is described in this article. Whether complicated or not, vesicovaginal fistulae must be treated by an experienced specialist, as experience only guarantees that the communication will be closed and normal continence restored.