Couvelaire R
J Urol (Paris). 1982;88(6):353-8.
The author reviews the therapeutic indications (it being necessary to abstain from repair of certain fistulae) in vesico-vaginal fistulae. Fistulae following pelvic irradiation, african fistulae of obstetric origin and the various difficulties (and their possible solutions) which may arise when the fistula passes through an extensive zone of fibrous tissue, is close to a ureteric orifice, at the neck of the bladder or associated with a loss of the urethra or with a recto-vaginal fistula, are studied. In the opinion of the author, classification between simple and complex vesico-vaginal fistula corresponds better to reality than the historical classification into high and low fistulae. The preferred surgical approach remains vagino-perineal. Finally, the complexity of the lesions may require combination of a surgical stage via a superior approach with the essential surgical stage which even today must be performed by an inferior approach.
作者回顾了膀胱阴道瘘的治疗指征（有必要避免修复某些瘘管）。研究了盆腔放疗后形成的瘘管、产科原因导致的非洲瘘管，以及当瘘管穿过广泛的纤维组织区域、靠近输尿管口、位于膀胱颈部或与尿道缺失或直肠阴道瘘相关时可能出现的各种困难（及其可能的解决方法）。作者认为，简单型和复杂型膀胱阴道瘘的分类比历史上的高位和低位瘘管分类更符合实际情况。首选的手术方法仍然是经阴道会阴手术。最后，病变的复杂性可能需要将经上入路的手术阶段与即使在今天仍必须经下入路进行的基本手术阶段相结合。
