Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula

Wang, Xingqi; Gao, Zhenhua; Li, Ling; Tian, Daoming; Zhou, Huayun; Shen, Jihong

doi:10.1007/s00192-023-05465-w

Cited by 5 publications

(1 citation statement)

References 21 publications

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“…Some of the tissues that have been reported as being interposed in the literature include labial fibrofatty tissue (more specifically, the Martius flap technique), peritoneum, omentum, gluteus muscle, rectus abdominis muscle, gracilis muscle, small intestinal submucosa, human dura grafts, sigmoid epiploicae, and urachus. (Rizwan, Zia et al 2021;Wang, Gao et al 2023) The efficiency of interposition flaps was examined by Espinoza et al 2019) in patients with benign etiologies. The majority of the 22 cases of vesicovaginal fistula (VVF) seen had a single orifice with an average diameter of 9.5 mm in a retrotrigonal position.…”

Section: Interposition Of Tissue and Its Importancementioning

confidence: 99%

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Fehintola,

Ajiboye,

Foyeke

et al. 2023

GJHS

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Female genitourinary fistula (FGF) is an atypical connection between the female genitourinary system and the urinary tract. The abovementioned issue presents a dire public health concern and significantly affects the affected individuals’ quality of life. The classification of fistulae arising from the genitourinary tract encompasses a range of types, including vesicovaginal (VVF), rectovaginal (RVF), uterovesical (UVF), and urinary fistula, with the particular manifestation dependent upon the site of perforation. The development of consistent guidelines for FGF care poses a challenge due to the variability of clinical conditions. The selection of an appropriate treatment protocol is contingent upon the surgeon conducting the treatment and the resources at their disposal. In the medical field, it is advisable for surgeons to contemplate implementing conservative treatment methods, particularly in patients thoroughly assessed and deemed suitable for this approach. Delayed repair of FGF results in superior outcomes compared to early repair. The transvaginal repair approach is favored due to its advantageous features. Anticholinergic pharmacotherapeutics may be employed during the postoperative phase to enhance the therapeutic course of the bladder. Healthcare providers can refer their patients to a tertiary care facility with advanced resources and specialized expertise, provided the necessary facilities are available. Surgeons undergoing training and adapting to emerging trends are advised to enhance their proficiency in repairing vesicovaginal fistula (VVF).

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Section: Interposition Of Tissue and Its Importancementioning

confidence: 99%

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Fehintola,

Ajiboye,

Foyeke

et al. 2023

GJHS

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Buccal Mucosal Graft as a Second Layer in the Vaginal Repair of Vesicovaginal Fistulas

Taha,

Mohamed,

Desoky

et al. 2025

Neurourology and Urodynamics

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ObjectiveVesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The most common cause of VVF is hysterectomy, while less common causes include obstetric trauma and pelvic surgery. Most cases require surgical intervention. Although various techniques have been described for the management of VVF, none has been considered the gold standard of management. In this study, we describe our technique using buccal mucosal graft (BMG) as a second layer in the repair of VVF through a vaginal approach.MethodsA total of 10 patients underwent surgery between May 2023 and December 2023. Patients were scheduled for follow‐up 3 weeks after surgery or earlier for any new symptoms of urinary incontinence, overactive bladder, or dysuria. Before catheter removal, a CT cystogram was performed to confirm fistula closure. Additional follow‐up visits were scheduled at 3‐6 months after repair to assess outcome.ResultsTen patients with a mean age of 35.7 ± 7.18 years were operated with the described technique. All patients had no recurrence of the fistula at the 6‐month follow‐up. None of them had additional morbidity due to the procedure. There were no post‐operative complications.ConclusionsAlthough the success rates of simple VVF are very high, the interposition of a tissue graft between the bladder and the vagina is required in the treatment of VVF, especially in those recurrent, large complex and radiation‐induced fistulas. The buccal mucosa has a thick epithelium that provides strength to the graft and a thin submucosa that is important for revascularization, so its use as a second layer in VVF repair may be beneficial. Its harvesting is a relatively simple procedure. It is not time‐consuming and is associated with low morbidity compared to Martius flap harvesting.

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Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report

Liu,

Cao,

Liu

et al. 2024

Medicine

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Rationale: Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. Patient concerns: A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o’clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Diagnoses: Self-inflicted complex VVF. Interventions: The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Outcomes: Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient’s quality of life. Lessons: The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

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Clinical efficacy of flap transfer coverage in the treatment of vesicovaginal fistula

Cited by 5 publications

References 21 publications

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Current Trends and Controversies on Female Genitourinary Fistula: A Review Article

Buccal Mucosal Graft as a Second Layer in the Vaginal Repair of Vesicovaginal Fistulas

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report

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