1. 56예의 요루에 대한 임상적관찰소견을 보고하며 원인별로는 난산으로 인한 요루발생수가 가장 많았다. 2. 수반된 제여건과 수술전처치와 예후에 관하여서 문헌적고찰과 경험을 기술하였다. 3. 수술의 방법에 있어서 여러가지 방법을 소개검토하였으며, 특히 Sims 방법과 Collins 방법을 가장 많이 시행하여 좋은 성적(제2표)을 얻었으나 suprapubic approach 는 만족할만한 결과를 얻지 못하였다. 4. 36예의 환자중 28예에서 1회수술을 하여 19예에서 성공하였으며 7예에서 2회의 수술을 하여 4예에서 성공하였으며 1예에 있어서는 4회 수술을 시도하였으나 실패하였다(제14표). 5. 수술후 감량으로 인한 합병증은 13예에서 볼 수 있었으며 뇨배양검사에서 E. Coli의 감량이 가장 많았다. 1예는 폐기전으로 수술후 18일에 급사하였으며 이는 부검으로 확인되었다. 4예에서 urinary incontinence 가 속발하였으나 이는 괄약근의 손상이 기능적으로 치유되지 못했기 때문이었다. 6. 수술의 실패에 대하여 검토해본 결과 제15표와 같은 결과를 얻었으나 특히 catheter 폐쇄로 인한 요루의 재발은 술후처치를 주의깊게 함으로서 피할 수 있는 점으로 사료된다.

Our study represents the review of the case histories of 36 patients admitted to or discharged from National Medical Center with diagnosis of urinary fistula, from January 1959 through end of 1963. The causes of these fistulas were analysed and methods of management were reviewed. Particular attention was paid to those patients in whom surgical repair of the fistula was carried out and an attempt was made to evaluate the factors responsible for success of repair. Of 56 cases of urinary fistulas studied, 26 were the result of obstetric dystocia and 16 were associated with abdominal operations including Wertheim`s operation and in the remainder of the cases the lesion were related to chemical cauterization for treatment of prolapse of uterus and TB. These cases were compared with Dr. Ruseel`s 74 cases, which besides ordinary obstetrical fisseries tulas also included urinary fistula due to radium therapy and vaginal operations, where as in our no such cases were seen. Six of the fistulas healed spomaneously. One was an obstetrical fistula while others five were fistula which occured as the result of radical operation for cervical cancer. In 36 patients operative procedure were carried out on 45 occasions. These operations were mostly designed to close the fistulous opening by the vaginal approach but in 15 cases abdominal approach was used. In 20 cases of large fistulas the ureteral orifices were found either at the edge of the fistula or near to it. In most of those cases extensive scar formation with poor circulation was found. Of these 20 cases eight were discharged as inoperable, five were operated by interposition of uterus or Martius operation in combination with layer to layer closure after insertion of ureter catheter. In the remaining 7 cases the fistulas were so large and fibrosis were so extensive that it was impossible to make sufficient mobilization of the surrounding tissue to make suture without tension. Operation was carried out in 86 cases, complete cure were 21, in complete cure in 4 cases where urinary incontinence followed after the operation despite closure of fistula, failure in 11 cases. Certain general principles for management of vesicovaginal fistula were described. 1) Complete urologic study and diagnosis. 2) Elimination of infection before and after operation. 3) Optimal time of operation about 6 months after fistula developed. 4) For good operative result it is very important to make good exposure of vaginal tract, to make complete excision of scar tissue, to make sufficient mobilization and suture always to apply sutures in healthey tissue without tension. 5) Continuous, effective postoperative bladder drainage for days should be carried out to allow solid healing of bladder wound.