URETHRO - VAGINAL FISTULA.
Fistula affecting the urethro-vaginal septum, and establishing a communication between the urethral and vaginal tracts without in volvement of the bladder, is rare.
Such fistula may arise from slough due to prolonged pressure dur ing labor, or from a buttonhole operation by which the communica tion has been artificially established for the purpose of relieving a urethrocele, or so-called hemorrhoidal condition of the mucosa, or on account of a tight stricture of the urethra.
In one instance I observed a fistula resulting from pressure, in which the small oval opening lying just in advance of the neck of the bladder was closed by silkworm-gut sutures after freshening of its margin, in the same manner as in vesico-vaginal fistula. The sutures in this case were placed transversely.
In another of my cases there was a urethro-vaginal fistula about a half-centimetre in advance of the neck of the bladder, and imme diately behind it a vesico-vaginal fistula about 2 cm. in diameter.
The anterior part of the urethra was entirely uninjured. The proced ure in this case, which was a peculiar one, was entirely successful. The tissue at the neck of the bladder was not sufficient in amount to allow a double denudation on anterior and posterior surfaces, neces sary to close the vesico-vaginal and urethro-vaginal fistulm in the or dinary way. The following procedure was therefore adopted : The bridge of tissue forming the neck of bladder was disregarded, and the oval denudation made to include both fistulm as if they were one. The edges of the wound were brought together by silkworm-gut sutures passed antero-posteriorly. The result was that urine dis charging from the bladder could pass either above the bridge of tissue into the internal orifice of the urethra, or below it, by a short circuit into the upper urethra. There was no incontinence as a result of the operation.