The vesico-vaginal fistula is an old disease, but
only in the last century has treatment been undertaken with
any confidence and with a fair chance of success. The
developments which I am going to write about are, therefore,
comparatively recent, and well worth critical examination and
The woman with a vesico-vaginal fistula leads
a miserable existence. She deserves the best that modern
surgery can offer her.
The repair of a vesico -vaginal fistula, though
often easy, can be extremely difficult and laborious.
The degree of difficulty is well illustrated in the
extensive literature on the subject.
Unless there has been severe damage to the
urethra, she should be cured of her incontinence by
The most favourable occasion to cure the patient
is the first operation.
Cure is most likely if attention is paid to the
smallest details of the case. In particular, there
should be most careful pre- operative examination and
re- examination, until the nature of the injury is clearly
and completely understood.
Because of the great variety of injuries seen,
there is no such thing as a routine method of closure.
The operation must be fitted to each case. Three
principles, however, learnt painfully and slowly, have
stood the test of time. Firstly, a depth of healthy,
vascular tissue must be exposed around the fistula.
Secondly, the closure of the opening must be without
tension. Thirdly, so far as possible the wound should
be kept at rest during the process of healing by continuous