Treatment of primary vesicovaginal fistula repair with bladder mucosal flap: a report of initial case series

Abstract

Objective: Vesicovaginal fistula (WF) is a disease that has been known for a long time. Most cases require surgical treatment. Although there are various techniques described for the management of WF, none have been attributed as the gold standard of management. In this study, we describe our own technique using a transabdominal approach with a mucosal flap prepared from the bladder.

Methods: A total of 14 patients were operated between December 2011 and February 2016. The patients were scheduled for follow-up at the 1st, 3rd, 6th, 12th, and 24th months, and outcomes were assessed in the following months. Treatment-associated complications and newly developing symptoms were recorded.

Results: Fourteen patients with a mean age of 28.5 +/- 5.58 years were operated using the described technique. All patients had no recurrence of the fistula at the 24th month follow-up.

Conclusions: Removal of ischemic tissue and utilization of a well-vascularized flap are important. Sutures inserted in each layer should not overlap and be devoid of tension. Although the success rates of a simple VVF is very high, the rates in patients with recurrent fistula or a fistula that developed because of radiotherapy or a malignancy are much lower. The technique that we employed is inspired from the hypospadias repair technique that involves a turn-over flap. We believe that having a short operation time, not using additional tissue for interpositioning, using the native bladder tissue for interpositioning, and a small incision to the bladder decrease the morbidities associated with surgery.