Urethro-vaginal fistulas: Our experience

Abstract

— Urethro-vaginal fistulas are rare in western countries, but more frequent in under-developed countries. In the latter this pathology is usually due to obstetric causes, whereas in European countries it arises mainly from gynaecological operations (82%). Results differ according to the cause. Almost all authors report a recurrence rate between 3 and 28%. We have chosen transvaginal urethroplasty with overlapping flaps from among the other more complex repair procedures which involve completing the fistulorraphy with myo-lipomatoso-cutaneous flaps. Our case histories (1988–1991) include 19 simple and 6 complex fistulas with the following etiology: gynaecological operation (16), obstetric causes (4), traumas (4). “Simple” fistulas were first treated by urethroplasty with overlapping flaps. Of 24 patients at 8-months follow-up, 82% of those operated once only, and 100% of those operated several times, had fully recovered. There were 2 recurrences due to Infection in the suture and 2 from tissue fibrosis. For “complex” fistulas and re-operations, we modify the Falandry method. We have concluded that transvaginal urethroplasty with several overlapping flaps is a valid procedure for non-recurrent fistulas which are limited in size and with little loss of fluid from ischemic dystrophy, which would otherwise, in our opinion, require the interpositioning of a myo-lipomatoso-cutaneous flap.