The challenging vesicovaginal fistula.

The authors report herein their experience in treating 75 cases of vesicovaginal fistulas. 80% were caused by gynecologic surgery and 20% were of obstetrical origin. The authors favor the transvaginal approach and describe in detail the two technics they recommend. The most commonly used method is the Chassar-Moir procedure. 70% of the patients were cured after one attempt with this procedure, and 93% after two operations. In complicated fistulas (irradiated or extended to the urethra) the Martius procedure was used. In this technic a flap formed from the fat tissue of one of the labia majora is interposed between bladder and vagina. 10 of 11 patients so treated were cured.