Neobladder-vaginal Fistula Repair with Modified Martius Bulbocavernosus Fat Pad Flap.
- Author:
Yujin MYUNG
1
;
Ji Ung PARK
;
Eui Cheol JEONG
;
Sukwha KIM
Author Information
1. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. alfbskan@gmail.com
- Publication Type:Case Report
- Keywords:
Vesicovaginal fistula
- MeSH:
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
- From:Journal of the Korean Society of Plastic and Reconstructive Surgeons
2011;38(3):329-332
- CountryRepublic of Korea
- Language:Korean
-
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.
