VESICAL FISTULAE INTO THE VAGINAL VAULT 1

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SUMMARY: One hundred and two of 422 vesical fistulæ personally treated since 1953 were either high in the vaginal vault or in the cervix. The majority were due to pressure necrosis during obstructed labour: 24 followed lower segment Cæsarean section, 16 followed hysterectomy and 2 resulted from the combined effects of surgery and radiotherapy. The repair techniques used by the author are summarised. Most of the fistulæ were approached per vaginam, but in 37 cases the fistula was fixed high in the pelvis and abdominal repair was therefore preferred, usually by the intravesical route. Four uretero‐vaginal fistulæ had to be dealt with subsequently. Eighty‐six fistulæ were successfully closed at the first attempt and the remaining 16 patients were all cured later except 2, who were lost to follow‐up.

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