Ureterovesicovaginal fistulas.

Our experience with urogenital fistulas are reviewed and three instances of complex ureterovesicovaginal fistulas, which can be mistaken for pure vesicovaginal fistulas because of diagnostic difficulties, are presented. If the ureterovaginal component of these fistulas is overlooked intraoperatively, urinary leakage will persist despite otherwise successful closure of the vesicovaginal component of the fistula. Because of the involvement of the terminal ureter in the fistulous system, operative therapy must combine the closure of the vesicovaginal fistula with reimplantation of the ureter into the bladder and interposition of omentum or a peritoneal patch between the bladder and vagina. Diagnosis and therapy are illustrated by patient reports and literature review.