Bladder mucosal autograft: An effective method for repair of vesicovaginal fistula

Mohseni, Mohammad G; Hosseini, Seyed R; Alizadeh, Farshid; Gooran, Shahram; Valikhani, Nadia

Bladder mucosal autograft: An effective method for repair of vesicovaginal fistula

Authors

¹ Department of Urology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran

² Isfahan Urology and Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Al-Zahra Hospital, Isfahan, Iran

³ Department of Urology, Private Practice, Iran

Abstract

Background: to investigate the effectiveness of bladder mucosal autograft for the treatment of vesicovaginal fistulae.
Materials and Methods: Between March 2005 and June 2011, 21 patients with a single vesicovaginal fistula above the trigone, not involving the ureters, underwent surgery. Bladder was approached extraperitoneally and opened in the midline. The mucosa around the fistula was incised and inverting sutures were placed over the fistula opening. The mucosal defect was covered by a free mucosal graft from the edge of cystotomy incision.
Results: After catheter removal at 2 weeks, 18 patients (85 %) remained dry while one patient experienced urge incontinence, which resolved in a few days and another one still had urine leakage (although less than before the operation) that improved after another 3 weeks of bladder drainage. Only in one patient, the operation failed.
Conclusion : Short duration of hospitalization, simplicity of the procedure, avoidance of extensive bladder dissection, and extraperitoneal nature of the operation, along with a high success rate are the advantages of this procedure. This technique could be recommended for single fistulae not involving the ureters and not secondary to malignancies.

Keywords

References

1.	Fichtner J, Voges G, Steinbach F, Hohenfellner R. Uterovesicovaginal fistulas. Surg Gynecol Obstet 1993;176:571-4. [PUBMED]
2.	Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistula: Vaginal and abdominal approaches. J Urol 1995;153:1110-2. discussion 1112-3.
3.	Blandy JP, Badenoch DF, Fowler CG, Jenkins BJ, Thomas NW. Early repair of iatrogenic injury to the ureter or bladder after gynecological surgery. J Urol 1991;146:761-5. [PUBMED]
4.	Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 1992;175:501-6. [PUBMED]
5.	Elkins TE. Surgery for the obstetric vesicovaginal fistula: A review of 100 operations in 82 patients. Am J Obstet Gynecol 1994;170:1108-18. discussion 1118-20.
6.	Kelly J. Vesico-vaginal and recto-vaginal fistulae. J Obstet Gynaecol 1998;18:249-51. [PUBMED]
7.	Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: Obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv 1996;51:568-74. [PUBMED]
8.	O'Conor VJ Jr, Sokol JK, Bulkely GJ, Nanninga JB. Suprapubic closure of vesicovaginal fistula. J Urol 1973;109:51-4.
9.	Kiricuta I, Goldstein AM. The repair of extensive vesicovaginal fistulas with pedicled omentum: A review of 27 cases. J Urol 1972;108:724-7. [PUBMED]
10.	Turner-Warwick RT, Wynne EJ, Handley-Ashken M. The use of the omental pedicle graft in the repair and reconstruction of the urinary tract. Br J Surg 1967;54:849-53. [PUBMED]
11.	Nesrallah LJ, Srougi M, Gittes RF. The O'Conor's technique: The gold standard for supratrigonal vesicovaginal fistula repair. J Urol 1999;161:566-8. [PUBMED]
12.	Coleman JW, Albanese C, Marion D, O''Dell G, Amberson J, Quiguyan CC, et al. Experimental use of free grafts of bladder mucosa in canine bladders, successful closure of recurrent vesicovaginal fistula utilizing bladder mucosa. Urology 1985;25:515-7.
13.	Brandt FT, Lorenzato FR, Albuquerque CD. Treatment of vesicovaginal fistula by bladder mucosa autograft technique. J Am Coll Surg 1998;186:645-8. [PUBMED]
14.	Ostad M, Uzzo RG, Coleman J, Young GP. Use of a free bladder mucosal graft for simple repair of vesicovaginal fistulae. Urology 1998;52:123-6. [PUBMED]
15.	Sharifi-Aghdas F, Ghaderian N, Payvand A. Free bladder mucosal autograft in the treatment of complicated vesicovaginal fistula. BJU Int 2002;89(Suppl 1):54-6. [PUBMED]
16.	Vyas N, Nandi PR, Mahmood M, Tandon V, Dwivedi US, Singh PB. Bladder mucosal autografts for repair of vesicovaginal fistula. BJOG 2005;112:112-4. [PUBMED]

Advanced Biomedical Research