Classification

Many different fistula classifications have been proposed, based on anatomical site; these are often subclassified into, simple fistulas (where the tissues are healthy and access good) or complicated fistulas (where there is tissue loss, scarring, impaired access, involvement of the ureteric orifices, or a coexistent rectovaginal fistula). Urogenital fistulas may be classified into urethral, bladder neck, subsymphysial (a complex form involving circumferential loss of the urethra with fixation to bone), midvaginal, juxtacervical or vault fistulas, massive fistulas extending from bladder neck to vault, and vesicouterine or vesicocervical fistulas. While over 60% of fistulas in the developing world are midvaginal, juxtacervical or massive (reflecting their obstetric aetiology), such cases are relatively rare in Western fistula practice; 50% of the fistulas managed in the UK are situated in the vaginal vault (reflecting their surgical aetiology).

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