Urinary Tract Fistula

Shin, Keum Dong

Abstract

Ninety-six cases of urinary tract fistulas, which were admitted to Severance Hospital during the period from Jan. , 1960 to Dec. 1969, were analyzed clinically and statistically. They were investigated by comparing with previous papers. 1) The rate of urinary tract fistulas accounted for 2.4 per cent of the total admissions to the Urologic Department and 0.057 per cent of Obstetrics and Gynecologic Department during 10 years. Twenty-eight cases of all fistulas were in men and sixty-eight in women. The age distribution was much the same as that found in previous literature. The most common age was from 20~50 years with 91.7 per cent. 2) The most commonly involved site was the bladder with 64.5 per cent and the most common fistula type was vesicovaginal with 42.6 per cent of those involving bladder. 3) About forty-seven per cent of all fistulas occurred after previous pelvic operation, seventeen per cent due to carcinoma of pelvic organs and thirteen per cent due to abnormal delivery. Chemicals, radiation, infection, trauma, foreign body and stone of the urinary tract were listed frequently as an etiologic factors. 4) The incidence of ureteral injury during radical hysterectomy was variable in the literature, but it accounted for 10 per cent generally. Among the 10 per cent of ureteral injury, ureteral fistulas developed in 20 per cent of our cases, but in 12 per cent of Meig's. 5) There are many surgical approaches to repair urinary tract fistulas according to the surgeon's taste, fistula type, location, size or number, previous attempts and adhesion of surrounding tissues. No two fistulas are exactly alike, and surgical approach to any fistula must be well thought before the time of operation. The operation must be fitted to the fistula, not the fistula to the operation. 6) To repair urinary tract fistula is today a somewhat difficult problem, and the operative failure rate in our 41 cases of vesicovaginal fistula was 34.4 per cent.