The following case is presented not only because it rather typifies the cases of vesicovaginal fistula encountered, but also to report the successful repair of an unusually large vesicovaginal fistula and to call attention to certain measures adopted in the postoperative treatment which we felt were of definite value in the successful outcome of the problem.
The patient was a married housewife, 50 years of age, whose chief complaint was leakage of urine from the vagina. Three years previous to admission, amputation of the cervix had been performed, following which urine did not pass normally but dropped into the vagina. The presence of a vesicovaginal fistula was recognized and during the following year three attempts had been made to close it; two, according to the history, were done by the vaginal route and the third was a suprapubic cystotomy. However, all these operations had been unsuccessful and for two years, urine had been leaking constantly through the vagina, all the urine being passed in that way as the patient was unable to retain any urine in the bladder. The patient had been married for ten years, had had no children, and there had been no pregnancies. The past history was essentially negative and there had been no serious illnesses.
On physical examination, the patient was found to be a well-developed, rather obese woman who weighed 163½ pounds. Her blood pressure was 130 systolic, 80 diastolic. Examination of the head and neck yielded no positive findings and the heart and lungs. . .