Repair of vesicovaginal fistula caused by radiation therapy with labia maiora skin flap

Abstract

Introduction Vesicovaginal fistula can occur after delivery, gynaecologic or urologic surgery, irradiation therapy or as destruction caused by a tumour or trauma. The main problem after irradiation is decreased elasticity of the tissue around the fistula. We present our experience in the treatment of three patients with vesicovaginal fistula using a labia maiora skin flap. Case Outline From May 2007 to January 2008 three patients with vesicovaginal fistula were treated using labia maiora skin flap. The fistulae occurred after mean 19 months (11, 20 and 26 months) following irradiation therapy applied to treat malignant disease. The mean age of the patients was 54 years (47, 53 and 62 years). The mean diameter of the fistulae was 3.5 cm (2, 4 and 4.5 cm). Using transvaginal approch, all devitalized and fibrous tissue was removed with the closure of the bladder wall. The labia maiora skin flap with good vascularization was transposed to close the defect and anastomozed to the vagina. The mean follow-up was 16 months (13, 17 and 18 months). Labia maiora skin flap size was mean 3.7 cm (2.6, 3.7 and 4.8 cm). We achieved satisfactory outcome in all patients. There were neither postoperative complications nor fistula recurrence. Conclusion Labia maiora skin flap presents a good alternative for surgical treatment of vesicovaginal fistula. The flap is more adequate for larger defects and for the repair of fibrously changed vaginal wall which is present after irradiation therapy. .

Keywords

• vagina
• bladder
• vesicovaginal fistula
• labia maiora
• reconstruction
• radiation therapy