[Complexity-oriented surgical strategies in vesicovaginal fistulas].

Since 1975 a total of 55 patients with vesicovaginal fistulas have undergone surgery at the Clinic of Urology, University of Saarland, Homburg/Saar. A majority (55%) of the cases were complicated. In 9 cases supravesical urinary diversion was necessary. Successful closure of the fistula was achieved in 45 patients (81.8%); only in one case is the fistula still present. In 5 patients with uncomplicated fistulas successful closure was accomplished by a vaginal approach. In the presence of complications, e.g., previous radiotherapy or accompanying lesions of the ureter or rectum, a transvesical/transabdominal approach was preferred; surgery was successful in 93.3% of such cases.