[African vesico-vaginal fistulas (author's transl)].

Obstetrical vesico-vaginal fistulas in Africa are very frequent and are correlated with the insufficiency or even the lack of health structures and sanitary conditions. They follow up a dystocic parturition, and their prevention requires a correct surveillance of pregnancy and parturition. Their pathogenesis consists in a durable compression of the pelvic cavity by the foetal head, inducing ischemia and later on necrosis. Their difficult treatment is based on clinical inspection which makes possible to distinguish several pathological types of fistulas. Surgical tactic will be selected according to the size of the fistula, the conservation or the destruction of the uretra with the vesico-uretral sphincters, the importance of perifistula sclerosis. BRACQUEHAYE'S operation is the basis of the conservatory treatment, associated or not with a technic restoring the urinary continence: either the INGELMAN-SUNDBERG operation of the LE GUYADER rectomyoplasty. When uretra is destroyed, the best palliative intervention is probably the building up of a rectal neobladder. These operations can be performed under conditions often prevailling in Africa. In most cases, they have restored normal social life for the women affected. But setbacks are not rare, and demonstrate the importance of prophylaxis.