The use of a rotational bladder flap for the repair of recurrent mixed trigonal–supratrigonal vesicovaginal fistulas

Abstract

The rotational bladder flap technique is safe and effective for the repair of complex, mixed trigonal-supratrigonal VVFs which always require tension-free approximation.

Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition

“…One of 18 patients had urinary frequency and nocturia in our study. By way of the rotational bladder flap repair, the incidence of voiding dysfunction was 6 of 34 and 0/9 in studies conducted by Ezzat et al and Sharifiaghdas et al, respectively. In fact, the urinary dysfuntion problem was not only attributed to the transabdominal repair.…”

“…In 2006, Dalela et al performed the technique without retropubic gap separation and anterior bladder wall incision, with a success rate of 100% (26/26). The modified O'Connor repair was used by Ezzat et al in the US and Sharifiaghdas et al in Iran, with success rates of 90% (9/10) and 88% (31/35), respectively. In our study, because all of the fistulas were located in the trigonal or supratrigonal region (two in primary cases and three in recurrent cases had bladder dome‐located fistulas).…”

“…We chose rotational bladder flaps to repair the fistulas on the contralateral side of the bivalved bladder. Tension‐free closure with healthy and vascularized flaps from the bladder wall were obtained in all of the cases; however, Sharifiaghdas et al reasoned that if concomitant unilateral ureteral re‐implantation is needed, rotation of the bladder flap from the same site is limited and this technique may not be suitable if bilateral ureteral re‐implantation is needed. Further, according to Christopher, this method of repair has the potential disadvantage of an increase in voiding dysfunction and a decrease in bladder capacity.…”

“…During the last decade, many surgical techniques have been developed in the process of treating VVFs, including transabdominal, transvaginal, and endoscopic approaches. It has been reported that if the tissue conditions are optimal and general surgical principles for fistulas are observed (i.e., adequate exposure of the defect, tension‐free closure, and preservation of an appropriate blood supply in the region), the overall success rate of repairing VVFs should be > 90% . Some patients present with complex fistulas, which have typically been defined as fistulas occurring after prior repair(s) or previous radiotherapy .…”