Transvaginal mobilization and utilization of the anterior bladder wall to repair vesicovaginal fistulas involving the urethra.

Abstract:

:Repair of vesicovaginal fistulas resulting from obstetric trauma remains a major challenge to surgeons worldwide. Large defects that result in partial or total urethral loss are especially difficult to repair. Even when closure of such fistulas is accomplished, return of normal urogenital function is often impaired, underscoring the need to improve existing surgical procedures. Transvaginal urethral and bladder neck reconstruction using mobilized anterior bladder wall was helpful in closing 18 of 20 vesicovaginal fistulas with urethral involvement caused by obstetric trauma. This method involves advancement of an anterior bladder wall flap into the vagina, where it is rolled into a neo-urethra or connected to whatever remnant of urethral tissue exists. Complications included stress incontinence requiring further surgery (four), small bladder capacity with detrusor instability (two), urethral stenosis requiring dilatation (two), postoperative hemorrhage (one), and vaginal stenosis (one). Continued modification of this procedure holds promise for many patients considered inoperable in the past.

journal_name

Obstet Gynecol

authors

Elkins TE,Ghosh TS,Tagoe GA,Stocker R

doi

10.1097/00006250-199203000-00026

subject

Has Abstract

pub_date

1992-03-01 00:00:00

pages

455-60

issue

3

eissn

0029-7844

issn

1873-233X

journal_volume

79

pub_type

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