Zimmern P E, Hadley H R, Raz S
J Urol (Paris). 1984;90(5):355-9.
We herein report our experience in the transvaginal repair of 30 consecutive cases of non-radiated Vesicovaginal Fistulae. The new principles applied include: early surgery as soon as the fistula is recognized, no excision of the fistulous tract to avoid retraction and bleeding of the margins as well as to provide protection of the ureteric orifices, closure of the intact fistula in two layers, rotation and advancement of the vaginal flap to cover the fistula avoiding overlapping of suture lines, and finally assurance of adequate bladder decompression with both a suprapubic tube and an urethral catheter. In the followup period of 6 to 72 months, we experienced a 94% success rate at primary repair with only two failures which are now dry after subsequent trans-vaginal closure. In spite of size, location or proximity to the ureteric orifices, the vaginal approach has proved to be amenable in all cases with minimal discomfort for the patient, a shorter hospital stay and equal or even better results than the more extensive abdominal approach.
我们在此报告连续30例非放射所致膀胱阴道瘘经阴道修复的经验。应用的新原则包括：一旦确诊瘘管即尽早手术；不切除瘘管，以避免边缘回缩和出血，并保护输尿管口；分两层关闭完整的瘘管；旋转并推进阴道瓣以覆盖瘘管，避免缝线重叠；最后通过耻骨上管和尿道导管确保膀胱充分减压。在6至72个月的随访期内，我们的一期修复成功率为94%，仅两例失败，后续经阴道闭合后现已无漏尿。无论瘘管大小、位置或与输尿管口的距离如何，经阴道手术已被证明适用于所有病例，对患者的不适最小，住院时间较短，结果与更广泛的腹部手术相当甚至更好。
