Labial cutaneous flap interposition in the treatment of recurrent vesicovaginal fistula

Abstract

Background: Recurrent vesicovaginal fistula (VVF) repair can be very difficult. Most gynecologists prefer the vaginal route because of the complexity of the abdominal approach. This article presents a simple procedure-a minimally invasive approach-labial cutaneous flap intertposition, that was used to treat an elderly patient with VVF. A cutaneous flap has good vascularity, allows augmentation of the bladder, and permits a vaginal approach. Case: A 72-year-old woman had VVF due to prolonged obstructed labor 30 years prior and had undergone transvaginal primary layered repair for this reason. Later on, she underwent total abdominal hysterectomy (TAH) and sacrocolpopexy to address uterine prolapse and cystocele. VVF developed after the TAH and sacrocolpopexy procedures. After the first postoperative month, she had recurrent urinary incontinence. A fistula between the bladder neck and vagina was noted when she had a vaginal examination and cystoscopy. A cutaneous labial flap was used to repair this recurrent VVF. Results: The labial cutaneous flap for repair of this patient's VVF was used successfully. The patient had no more evidence of recurrent VVF or voiding abnormalities after this procedure. Conclusions: Labial cutaneous tissue can be used to create a successful interposition flap during repair of recurrent VVF, particularly in elderly patients.