J Korean Soc Plast Reconstr Surg.  2011 May;38(3):329-332.

Neobladder-vaginal Fistula Repair with Modified Martius Bulbocavernosus Fat Pad Flap

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. alfbskan@gmail.com

Abstract

PURPOSE
In developed countries, vesicovaginal fistula occur from various pelvic operations including total hysterectomy, leading to urinary leakage and incontinence. Although various methods have been proposed for adequate tissue coverage in fistula repair, the surgical treatment of is not simple and still controversial. We report a case of neobladder-vaginal fistula repair using modified Martius fat pad flap.
METHODS
A 62-year-old female patient underwent radical cystectomy with total abdominal hysterectomy and neobladder formation due to invasive bladder tumor 5 years ago. For 3 years following the operation, urine leakage was observed. Exploration demonstrated neobladder-vaginal fistula and primary repair including fistulectomy and direct closure was performed. Urinary incontinence relapsed 2 years after primary repair, and after demonstrating the recurrence of fistula on urography, repair of recurrent fistula was performed. After dissection of vagina and neobladder and closure of fistula by urologic surgeon, fibroadipose flap was elevated, rotated and advanced through the tunnel at vaginal sidewall, and interpositioned to the fistula site between neobladder and vagina.
RESULTS
There was no acute complication after the surgery and urethral catheter was extracted on the 8th day after the operation. During six month follow-up period after the operation, there is no clinical evidence of fistula recurrence.
CONCLUSION
From our clinical experience and literature review, we think Martius fat pad flap is a useful technique in management of neobladder-vaginal fistula, for it provides enough vascularity, major epithelization surface and better lymphatic drainage, and also prevents overlapping of vesical, vaginal suture lines at the same time.

Keyword

Vesicovaginal fistula

MeSH Terms

Adipose Tissue
Cystectomy
Developed Countries
Drainage
Female
Fistula
Follow-Up Studies
Humans
Hysterectomy
Middle Aged
Recurrence
Sutures
Urinary Bladder Neoplasms
Urinary Catheters
Urinary Incontinence
Urography
Vagina
Vesicovaginal Fistula
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