Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius : une expérience camerounaise

Tebeu, Pierre Marie; Domgue, Joël Fokom; Fosso, Gisèle Kengne; Biyaga, Paul Tjek; Fomulu, Joseph Nelson; Rochat, Charles-Henry

doi:10.1016/j.purol.2015.07.005

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…13,21,36,46,47,[53][54][55] All retrospective nonrandomized comparative studies (30 studies) and prospective nonrandomized comparative studies (5 studies) were considered high risk of bias because these studies evaluated interventions designated by surgeon preference, varied in their follow-up, provided limited information on evaluation of cure, and did not control for confounding factors. 14,[16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35]37,[39][40][41][42][43][44][45]48,49,51,52,[56][57][58] One comparative study, by Geisler et al, 25 reported preoperative assessment of the fistula for surgical planning. This prospective nonrandomized comparative study (N553) describes the use of phenazopyridine given preoperatively to identify fistula tracts.…”

Section: Resultsmentioning

confidence: 99%

“…The evaluated domains included route of repair and the use of flaps, trimming, layered closure, antibiotics, fascial sling, and fibrin glue (Table 1). 13,14,[16][17][18][20][21][22][23][24][27][28][29][30][31][33][34][35][36][37][40][41][42][44][45][46][48][49][50][51][52][53][56][57][58] Seventeen studies were identified (two prospective nonrandomized comparative studies, 15 retrospective nonrandomized comparative studies) that evaluated vaginal compared with abdominal (through laparotomy) routes of vesicovaginal fistula repair (N51,143). 14,16,18,20,24,29,30,33,35,37,40,41,…”

Section: Resultsmentioning

confidence: 99%

“…Six studies (N5924) compared vaginal repair with and without an interpositional flap. 13,17,22,45,50,52 The most common flap used was the Martius labial fat pad. Meta-analysis of these six studies showed that use of an interpositional flap with a vaginal route of repair does not increase the rate of successful fistula closure (RR 0.98, 95% CI, 0.96-1.01) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Repair of Vesicovaginal Fistulae

Thompson,

Halder,

Jeppson

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES: PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION: This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck–vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS: Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION: Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021214948.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Repair of Vesicovaginal Fistulae

Thompson,

Halder,

Jeppson

et al. 2023

Obstetrics &Amp; Gynecology

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“…As discussed previously (4) the poorer continence outcomes may have been confounded by indication as stratified analyses suggest those fistulae repaired with a Martius flap may have been more complex (more difficult to repair and have known higher rates of incontinence). A second series of 81 genitourinary fistulae operated on by a single surgeon (27) of which 28 (34.6%) received a MMLFPF, found the addition of a flap made no difference in the overall closure rate (85.7% vs. 79.2%, P=0.347) nor the closure of fistula with continence (60.7% vs. 67.9%, P=0.260). This small unrandomized series suggests in women where the fistula characteristics are thought to be poor enough to warrant interposition tissue, that its use yields surgical outcomes equivalent to those in milder cases not needing interposition.…”

Section: Discussionmentioning

confidence: 99%

How and why to take a Martius labial interposition flap in female urology

Wilson¹,

Pillay²,

Greenwell³

2017

Transl. Androl. Urol.

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The Martius modified labial fat pad flap at nearly 90 years old is still very much part of the modern vaginal surgeon’s armamentarium. Here we describe this straightforward and adaptable technique, the avoidance of pitfalls, its advantages and uses in vaginal surgery, and outcomes both short and long term. Specifically patient reported outcomes related to scar perception and sexual function are explored.

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“…More bladder tissue is lost and vaginal scarring is often also more severe with circumferential fistulas resulting in residual incontinence more frequently 27. Repeat procedures are common after failed closure, and some authors argue that an interpositional layer with a new vascular supply in the form of a gracilis flap should be used as the Martius graft has not demonstrated improvements in patient outcomes 28,29. The first attempt is still widely considered to be the best chance for success and therefore, triaging cases according to surgical skill would optimize outcomes.…”

Section: Treatment Of Obstetric Fistulasmentioning

confidence: 99%

Obstetric and Gynecologic Genitourinary Fistulas

Abrams

Pope

2021

Clinical Obstetrics &Amp; Gynecology

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Urinary incontinence shortly after childbirth or gynecologic surgery can be the result of obstetric or iatrogenic fistula formation. This can be a confusing and challenging diagnosis for medical providers. While the number of iatrogenic fistula cases is rising worldwide, obstetric fistulas are an issue uniquely particular to resource poor settings. Appropriate treatment of genitourinary fistulas spans beyond surgical intervention of leakage, and includes re-integration into the community, widespread education and counseling, and battling social stigma and cultural biases. Current and future research must focus on rigorous, unified efforts to set evidencebased practices to help the millions of women affected.

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Étude comparative du résultat de la cure des fistules vésico-vaginales avec et sans interposition du lambeau de Martius : une expérience camerounaise

Cited by 10 publications

References 12 publications

Repair of Vesicovaginal Fistulae

Repair of Vesicovaginal Fistulae

How and why to take a Martius labial interposition flap in female urology

Obstetric and Gynecologic Genitourinary Fistulas

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