Urovaginal fistulas: 20 years of experience with 45 cases.

We treated 45 patients with urovaginal fistulas owing to operative gynecological procedures and radiotherapy: 36 had vesicovaginal and urethrovaginal, 6 had ureterovaginal and 3 had rectovesicovaginal fistulas. Reconstruction was performed in 40 patients, mainly via a transvesical approach. There was good success in patients not given radiotherapy: 24 of 26 patients experienced primary healing and no failures were noted. Of the 14 patients treated by irradiation 9 had primary healing and 3 failed therapy. Patients with a urovaginal fistula should be referred to centers with special interest in this type of repair. An alternative surgical technique with the carbon dioxide laser deserves consideration in patients with scarred and irradiated tissue.