The Martius Flap's Effectiveness in the Repair of Vesicovaginal Fistulae

Abstract

Objective: The study sought to determine the efficacy of the Martius flap in treating difficult VVF (Vesicovaginal fistula) greater than 2.5 cm in size.

Study design: A descriptive case series

Place and duration of study: From January 2018 to December 2020, this study was conducted in the department of urology at Khalifa Gulnawaz Teaching Hospital in Bannu.

Methodology: The patients' case records were evaluated. Following a vaginal examination to establish leakage, all patients had cystoscopy to determine the fistulae, location, and tissue scarring. All patients had a CT urogram and cystogram, as well as a urine c/s. A modified Martius flap repair was carried out. They were released on the second surgical day and were monitored for three months.

Results: Ninety individuals had vesicovaginal fistulas repaired using a modified Martius flap. The patients' average age was 35 years. Obstruction of labor was the most common etiological cause in 70 (77.7%) of the patients, followed by gynecological procedures in 16 (17.7%). Twenty patients (22.22% of the total) underwent surgery to treat recurrent fistula formation. After surgery, 7 (7.7%) patients exhibited stress incontinence and were treated conservatively with pelvic floor exercises. Three (3.3%) women had vaginal bleeding, and two (2.2%) had labial wound infections. Recurrence occurred in two (2.2%) of the patients.

Conclusion: The modified Martius flap is a successful therapeutic method for vesicovaginal fistula with fewer complications and great aesthetic results.