Malignant tumors were responsible for 19 cases of urogenital fistula, including 10 ureterovaginal and 9 vesicovaginal fistulae, treated between 1974 and 1982. Details of the cases are reviewed and the therapeutic attitude to adopt towards urogenital fistulae of malignant tumor origin discussed. Recommended steps are: repeat plastic surgery as soon as possible after the postoperative appearance of the fistula, conservation of the kidney for as long as possible, and small intestine replacement of the ureter in selected cases. External as compared with internal urinary shunts are preferred in cases of advanced lesions with renal failure, tumor recurrence, or cobalt therapy. Cutaneous ureterostomy in Y with a single median or right lateral skin opening appears to be an excellent bypass procedure enabling a left colostomy to be performed, either primarily or secondary in case of rectal invasion.
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