=Uretero-vaginal Fistula.=--This condition is usually the result of injury to the ureter by operation. It may occur from the destruction of tissue caused by pelvic abscess, which discharges through the vaginal vault. In extensive vesico-vaginal fistula caused by sloughing after labor the bladder-wall may become rolled out so that the ureter opens into the vagina. If but one ureter is involved, one-half of the urine will be discharged in the natural way and the other half by the vagina. The _treatment_ consists in directing the ureter into the bladder by plastic operation performed through the vagina; or by performing celiotomy, dissecting out the ureter, and implanting it in the fundus of the bladder. =Recto-vaginal Fistula.=--Recto-vaginal fistula is usually caused by parturition. The destruction of tissue is sometimes due to syphilis. In the latter case cure is difficult, and sometimes impossible. The _symptom_ of the condition is the passage of feces and flatus into the vagina. Sometimes but a very small opening exists, situated immediately above the sphincter muscle; in other cases the greater portion of the recto-vaginal septum is destroyed. The condition may be recognized by placing the woman in the lithotomy position and exposing the posterior vaginal wall by the Sims speculum placed under the pubic arch. The _treatment_ consists in operation similar to that described under the consideration of vesico-vaginal fistula. The woman should be prepared as for a plastic operation upon the perineum. The rectum should be thoroughly emptied before operating. The sphincter ani should be stretched. It is always advisable, when possible, to close the opening from the vagina. The mucous membrane of the rectum should be injured as little as possible, in order to limit the bleeding. It may be necessary to relieve tension on the edges of the fistula by making, on each side of the vaginal aspect of the opening, an incision parallel to the long axis of the vagina. In case of a small fistula situated immediately above the sphincter ani, it is sometimes difficult to denude and to introduce the sutures. It then becomes necessary to divide the perineum and the sphincter ani to the fistula, denude the edges, and to introduce sutures as in a case of complete median laceration of the perineum. Sometimes the recto-vaginal fistula is much larger on the vaginal than on the rectal aspect--is, in fact, funnel-shaped, the destruction of tissue having been greater upon the vaginal surface. If in such a case the edges of the fistula cannot be brought into apposition after freeing all restraining bands, it may be necessary to split the edge of the opening, so that the rectal wall is freed and may be brought together by sutures introduced through the rectum, leaving the vaginal opening to be filled by granulation. The rectal sutures may be introduced by placing the woman in the Sims position and exposing the anterior rectal wall with the Sims speculum.