Plastic surgical techniques in the repair of vesicovaginal fistulas: A review

Abstract

A variety of plastic surgical techniques may be used in the repair of vesicovaginal fistulas. The indication for their use include: (a) diameter greater than 4 cm; (b) involvement of the bladder neck/proximal urethra; (c) radiation-induced fistulas; and (d) previous failed repair(s). In the developing world the vast majority of complex fistulas are caused by obstetric trauma; elsewhere they occur mainly following radiotherapy or radical surgery for gynecologic malignancy. The majority of complex fistulas requiring tissue donation may be effectively treated using a vaginal approach and a modified Martius graft. There is probably little or no advantage in encorporating bulbocavernosus muscle fibers in this graft. Although some concern exists regarding the long-term viability of these grafts in radiation-induced fistulas, in view of the relatively simple operative technique, together with the low associated morbidity, modified Martius grafts may be deemed suitable for first-time repairs. The gracilis muscle graft should be considered next in cases of exclusive transvaginal repair. The omental graft is undoubtedly the most versatile: it can be used in both abdominal and combined abdominovaginal procedures. The recently described posterosuperior sliding bladder flaps warrant further evaluation. For most fistulas involving the bladder neck/proximal urethra, there is no clear advantage in bladder flap reconstruction over vaginal flap reconstruction, the latter being augmented by an anti-stress incontinence procedure were appropriate. When continent urinary diversion is required, the Indiana pouch appears preferable to the Kock pouch; ureterosigmoidostomy is, however, technically

Outcome of using a modified surgical technique for the repair of complex vesicovaginal fistulas in Nigeria

“…The described modified repair technique used in this study employs a third layer of repair, which reinforces the suture line and reduces further the risk of failure. Even though, modified methods of VVF repair like plastic surgical techniques and Martius flap procedure have been utilized by different authorities with some successes, [15][16][17] the reported modified method of VVF repair is innovative, as literature search did not yield any positive finding.…”

Repair of vesicovaginal fistula by the transabdominal route: outcome at a north Indian tertiary hospital

“…The vaginal wall is closed first followed by bladder closure [7][8][9][10][11]. Since the omentum or the peritoneum cannot be used as interposition graft, this method of abdominal VVF repair is less popular [10][11][12][13][14][15]. Intraperitoneal approach is the popular method of fistula repair since interposition flap can be used as described earlier.…”

Laparoscopic repair of a vesicovaginal fistula using an omental J flap

“…A variety of tissues can be interposed between the bladder and vagina to aid closure: omentum 3,5 , a flap of peritoneum 6 , gracilis muscle, a flap of bladder wall taken from a site away from the fistula, or an epiptoic appendix taken from the sigmoid colon 1 . Omentum is the most commonly used in vesico‐vagmal fistula repair in the literature concerning open surgery 5,7 . It is able to aid in the resolution of inflammatory processes, supplying excellent lymphatic drainage.…”