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It is reported on 20 cases of ureterovaginal fistula after hysterectomy. In all cases renal protection (nephrostomy) was compulsory. Spontaneous healing without stenosis occurred in 6 cases, in 10 cases urethral reimplantation was successful, in 4 cases nephrectomy had to be carried out. Tactics of the therapy are described from the urologic viewpoint. Pre- and postoperative marks with relevance for prognosis and the special following-up are especially emphasized in this connection.

At first the general problems of operations in the x-ray treated tissue are discussed. After that 11 cases of patients, who were x-rayed, were demonstrated. With these patients we carried out a radical operation, because the cancer of cervicis was insufficiently affected by a primary radiological therapy. The bad turn of disease could not be stopped at 6 cases. The women patients got either uretero-vaginal-fistulae (2) or recto-vaginal-fistulae (2) or combined vesico-recto-vaginal-fistulae (1) and in less than one year they died of recidiv of cancer. Two women patients are still tended on account of their vesico-recto-vaginal fistulae. Only three women had been cured satisfactorily and they are till now free of recidivs for 4 to 7 years.

The Paragalalith method, to dry off a fistula proved to be a complete success, when a complex vagina/small intestine fistula was removed from a 75 year old patient (woman). We had developed the method previously in our clinic and used it sucessfully to close 30 fistulas in the abdominal region.

Vaginography is recommended to detect and determine the exact location of uretero-vaginal fistulas and vaginal fistulas extending as far as into the upper intestine. Use of a modified Sengstaken probe for instillation of the contrast medium permits meaningful X-ray photographs to be obtained while ensuring definite sealing of the vagina to the outside.

The results obtained from treatment of 156 patients for ureterovaginal fistula are reported in this paper. Eighty-five per cent of the fistulae had developed in the wake of gynaecological operations. Vaginography played a major role in diagnosis. Spontaneous occlusion of fistulae occurred in 19 cases. Satisfactory results were recorded from nine patients by means of indwelling ureteral catheters. Cases of ureteral stenosis were tackled by means of corticosteroid therapy. Nephrectomy was necessary in 24 cases. A date between five and seven weeks from fistulation has proved to be the optimum time for ureteroplasty. Organ-saving operations were performed on 101 patients. Results were satisfactory in 82.1 per cent of all cases. This assessment is given with due consideration of renal function.

It is reported on the fistula cervico-laqueatica as a special form of female genital fistula. Symptoms, reasons, and effects as well as possibilities for avoiding and treating of these fistulas are represented.

Special conditions for plastic surgery on the upper urinary tract in cases of gynaecological radical hysterectomy are discussed in conjunction with one case of bilateral ureteral injury inflicted during the operation and one case of postoperative bilateral ureterovaginal fistulas. Today, Boari grafting is preferred rather than direct implantation. Oblique submucous canalisation (antireflux effect) in unnecessary in most cases. Two-stage operations would provide a better protection of the bladder than one-stage restorative treatment. In emergency cases unilateral nephrostomy or ureterostomy in situ may be considered as interim solution. Transperitoneal access is necessary only in cases of injury during operation or when a one-stage plastic operation has to be carried out. For subsequent reconstructive operations performed in two stages we would prefer the extraperitoneal approach.

A rare case of uterus duplex, atresia of the right vagina and a fistulisation of a praevesical and parametral absessus is reported. The importance of special gynaecological and urological investigations is stressed, especially if the cystic formation is located in the upper part of the vagina.