Henry van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).
INTRODUCTION AND HYPOTHESIS
Obstetric vesico-vaginal fistula is a traumatic complication of prolonged obstructed labor in which pressure necrosis from the impacted fetal head destroys portions of the vesico-vaginal septum, resulting in continuous and uncontrollable urinary incontinence. Ancient evidence suggests that fistula cases have probably been occurring since the development of rotational delivery mechanics in anatomically modern humans hundreds of thousands of years ago. It is likely that attempts to repair such injuries also have a long history. The early history of vesico-vaginal fistula surgery was investigated to determine the earliest credible report of successful cure of this condition.


METHODS
Historical review of vesico-vaginal fistula surgery was undertaken, focusing on the work of Henry Van Roonhuyse, a seventeenth century Dutch surgeon living in Amsterdam.


RESULTS
Van Roonhuyse's clinical treatise entitled Medico-Chirurgical Observations (1676) was reviewed in detail and is described in this article. His technique for vesico-vaginal fistula repair included six essential steps that are still recognizable today: (1) use of the lithotomy position; (2) exposure of the fistula with a speculum; (3) sharp paring of the fistula edge prior to attempted closure; (4) careful approximation of the denuded edges of the fistula; (5) dressing of the wound with absorbent vaginal packing; (6) immobilization of the patient in bed until the repair has healed.


CONCLUSIONS
Henry Van Roonhuyse is the most credible candidate presently known for having successfully repaired a vesico-vaginal fistula in the pre-modern era.
['Wall|L Lewis|LL|0000-0003-2133-7051']
D000328:Adult D005260:Female D013509:Gynecologic Surgical Procedures D049670:History, 17th Century D006801:Humans D009426:Netherlands D007744:Obstetric Labor Complications D011247:Pregnancy D019651:Reconstructive Surgical Procedures D014719:Vesicovaginal Fistula
Henry van Roonhuyse Vesico-vaginal fistula Fistula surgery Seventeenth century Obstetric fistula