Principles of management of the vesicovaginal fistula.

The aetiology, pathological anatomy and management of the vesicovaginal fistula are reviewed. Closure of the vaginal route is preferred by most gynaecological surgeons and is suitable for low-lying fistulas. A suprapubic approach is more suitable for high or tethered fistulas and is favoured by urological surgeons. The importance of meticulous preparation and care in the management of this condition is stressed.