The uses and outcomes of the Martius fat pad in female urology

Abstract

MFP interposition is associated with good cosmesis and a very low complication rate (<2 %). It appears to lower new onset post-procedure USUI, prevent erosion in the 'fragile' urethra and improve outcomes following repair of post-surgery VVF/UVF. MFP is a versatile and effective tool in the female urologists' armamentarium.

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

“…Among sexually active patients, equivocal sexual function outcomes were recorded across different surgical indications, although it is difficult to control for other factors such as primary vaginal surgery indication, age, health status when assessing sexual function outcomes. Our previously reported series (4) found minimal morbidity with only 2 haematomas, 1 labial wound infection and very good cosmesis—with 79% of patients rating the final cosmetic appearance as good or excellent and only 1 (0.6%) rating it as unsatisfactory.…”

“…Browning’s series of 440 obstetric VVF repairs (26) proposed that its use in this scenario be abandoned because of complications and lack of benefit (7) with a higher rate of postoperative incontinence in those with Martius flap interposition (44.9% vs. 16.5%). 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).…”

“…To improve healing and reduce fistulae or recurrence in urethral diverticulectomy (4,5), urethral mesh excision (4,6), vaginal repair of urethrovaginal (6) and vesicovaginal fistulae (6-8), and bladder neck closure for urethral erosion (9);…”

Ventral‐onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women

“…A modified Martius labial fat pad was interposed in all women to provide a healthy vascular base for the buccal mucosal free graft, reduce the risk of urethrovaginal fistula development and provide healthy tissue between the reconstructed urethra and the overlying vagina to facilitate any future surgery for subsequent SUI, should it occur. In our hands, this adds 20 min to the procedure and is associated with minimal morbidity and good cosmetic outcomes [14]. Postoperatively, the drain and vaginal pack were removed on day 2 and the patient discharged home when comfortable, to return at 3 weeks for a pericatheter urethrogram and trial of void if healed.…”

“…Female urethral stricture (FUS), although uncommon, has a large impact on quality of life, with urethral pain and recurrent infections causing much misery. BOO in women may be more common than previously believed, occurring in [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].4% of women presenting with LUTS [1,2], with FUS causing BOO and LUTS in 0.32-4.9% of cases [3][4][5]. Traditionally FUS has been managed using endoscopic techniques with or without intermittent self-catheterization (ISC).…”