REPAIR OF BLADDER FISTULAS

This paper contains a report of seventeen consecutive cases of bladder fistula successfully closed, together with a discussion of their causative factors, types of injuries sustained and the principles of operative procedure employed. The following cases were encountered: One vesico-uterine (fundus). Two vesicocervical. One vesico-urethrovaginal. Three large vesicovaginal, the opening being larger than a half dollar (30 mm.). Nine small vesicovaginal (quill to finger size). One anterior vesical injury (fistula under the symphysis pubis). Grouping them according to causative factors discloses the disturbing fact that practically all these injuries were sustained by direct trauma, of a more or less preventable character. They may be classified as follows: Eight fistulas following hysterectomies. One following criminal abortion. One after a cervical amputation. One following cystocele repair. Five due to obstetric manipulation. One following radium for carcinoma of the cervix. These various injuries merit discussion, for after critical examination only two cases can