Management of 18 difficult vesicovaginal and urethrovaginal fistulas with modified Ingelman-Sundberg and Martius operations.

Our experience in the management of difficult vesicovaginal and urethrovaginal fistulas is presented. The fistulas were secondary to radiation damage and extensive local fibrosis owing to previous attempts to repair surgically. Satisfactory surgical repair of the fistulas was obtained by interposition of viable gracilis muscle and labial fibrofatty tissue at the repair site. The patients have been followed for 1 to 2 years postoperatively.