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Chinese Journal of Clinicians(Electronic Edition) ›› 2022, Vol. 16 ›› Issue (07): 636-642. doi: 10.3877/cma.j.issn.1674-0785.2022.07.007

• Pelvic Floor Disorders·Clinical Research • Previous Articles     Next Articles

Clinical application of single-layer annular vaginal flap in transvaginal repair of vesicovaginal fistula

Min Tang1, Pu Li1, Chengming Wang1, Qian Zhang1, Xiaoxin Meng1,()   

  1. 1. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2022-03-08 Online:2022-07-15 Published:2022-10-08
  • Contact: Xiaoxin Meng

Abstract:

Objective

To compare the success rate and prognosis of repairing vesicovaginal fistula (VVF) via transvaginal and transvesical approaches, and to highlight a modified transvaginal repair technique which only requires single layer closure of an annular vaginal flap.

Methods

A retrospective analysis was performed on 57 consecutive patients who underwent VVF repair between 2007 and 2021. Fistula characteristics, operative factors, post-surgical complications, and outcomes were analyzed.

Results

A total of 57 women with a median age of 50.4 (range, 27~75) years were included. The history ranged from 7 days to 8 years, with an average of 20 months. The chief complain was vaginal leakage of urine. Fifty-six (98.2%) cases of VVFs were caused by pelvic surgery, and only one resulted from difficult labour. Eleven (19.3%) cases had a history of surgical repair failure. All the 57 cases of surgery were smoothly completed. Among them, 17 patients underwent transvaginal repair, whereas 40 (70.2%) women had transvesical repair. Transvaginal approach had a significantly shorter operative time, less intraoperative blood loss, reduced postoperative hospital stay, less hospitalization cost, and lower minor complication rate than the transvesical group (P<0.05). No serious complications occurred in either group. No cystostomy was performed in the transvaginal group, but 12 cases (30%) in the transvesical group had cystostomy. The average follow-up time was 18.5 (range, 3~48) months. The first-time success rates of transvaginal and transvesical techniques were 82.3% and 75%, respectively.

Conclusion

VVF repair with single layer closure of an annular vaginal flap is a technically feasible, simple, and successful approach with significantly better operative parameters and lower complications rates.

Key words: Vesicovaginal fistula, Single layer, Vaginal flap, Transvaginal, Transvesical

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