ABSTRACT
There is no standardized or universally accepted method for describing or classifying fistulas, although development of such a system has been recommended by the International Consultation on Incontinence to include location and size of the fistula, functional impact, and quantification of the degree of vaginal scarring. The classifications, reported by Waaldijk and Goh, are increasingly utilized in the evaluation of obstetric fistula, although have little value in the classification of other fistula etiologies. Other reported classifications tend to be based on anatomical site, 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), mid-vaginal, juxtacervical or vault fistulas, massive fistulas extending from bladder neck to vault, and vesicouterine or vesicocervical fistulas (Lawson, 1978). While over 60% of fistulas in under-resourced countries are midvaginal, juxtacervical, or massive (reflecting their obstetric etiology), 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 etiology). Rectovaginal fistulas are also classified according to anatomical site and relationship to the anal sphincter.
