Complicated Postirradiation Vesicovaginal Fistula in Young Women: Keep Off or Try Reconstruction?

Transvaginal repair of complex and complicated vesicovaginal fistulae

“…Meticulous dissection and placement of an interposition graft (a Martius flap if the labia are normal or a gracilis muscle flap) are required [19][20][21]. The gracilis muscle graft is an excellent interposition graft for transvaginal repair, particularly in women with radiation-induced fistulae [8,21]. In the present study, a Martius flap was used in 3 patients and a gracilis muscle flap in 1 patient.…”

“…Large VVF involving the trigone with extension to the urethra can be repaired in 2 layers. Urethral reconstruction is performed by using the anterior vaginal wall [8,17,22,23].…”

“…Devascularization of the adjacent tissue contributes to the high failure rate of surgery. Modified surgical techniques are required in such patients [8,10,16,17]. Meticulous dissection and placement of an interposition graft (a Martius flap if the labia are normal or a gracilis muscle flap) are required [19][20][21].…”

“…A fistula is said to be complicated if it is larger than 6 cm; if it is associated with a complete loss of the urethra or with severe scarring of the bladder; if it is rectovaginal; if the ureteric orifices are at the edge or outside of the fistula; if the woman has a small bladder or bladder calculi; and if the fistula has been induced by radiation therapy [5,6,8,9].…”

CASE REPORTS Retroperitoneoscopic ureterocutaneostomy as a method of urinary diversion in case of complicated urinary fistula after radiotherapy

“…The formation of post-irradiation fistula is caused by hypovascularization and massive fibrosis of the tissues; these factors also highly impair the healing process after surgical repair [5, 6, 7]. There are only few publications regarding laparoscopic ureterocutaneostomy [8–10].…”