Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Urology. 2012 Apr;79(4):950-3. doi: 10.1016/j.urology.2011.10.077. Epub 2012 Feb 25.
To present a modified surgical technique in the management of radiation-induced vesicovaginal fistulas. Radiation-induced vesicovaginal fistulas pose a great challenge to the treating surgeon owing to the fibrotic, poorly vascularized tissue in the area. Various techniques have been used to promote healing and prevent fistula recurrence, but most centers still recommend urinary diversion or more individualized management.
We used the left rectus abdominis muscle based on the deep inferior epigastric vessels as an interposition flap in 3 patients presenting with vesicovaginal fistulas 19, 28, and 34 years after radiotherapy for cervical cancer. The fistulas were isolated using an abdominal approach, and the distal half of the left rectus abdominis muscle was mobilized. Without closure of the 2 defects, the muscle was then interposed between the bladder and vagina, where it was fixed using single sutures around the edges of the 2 defects. The operations were performed by a team that included both a urologist and a plastic surgeon.
All 3 patients underwent successful treatment. With a follow-up of 5-8 years, there has been no recurrence of symptoms.
This modified surgical technique offers well-vascularized, nonirradiated tissue to be used as an interposition flap based on the inferior epigastric vessels in the management of radiation-induced vesicovaginal fistulas. The technique allows obstruction of the fistula without the need for closure of the mucosal defects in the bladder and vagina.
介绍一种改良的手术技术，用于治疗放射性膀胱阴道瘘。由于该区域纤维化和血供不良的组织，放射性膀胱阴道瘘对治疗医生来说是一个巨大的挑战。已经使用了各种技术来促进愈合并防止瘘复发，但大多数中心仍建议进行尿流改道或更个体化的管理。
我们在 3 名宫颈癌放疗后 19、28 和 34 年出现膀胱阴道瘘的患者中使用基于深下腹动脉的左侧腹直肌作为间置物瓣。通过腹部入路将瘘管隔离，游离左侧腹直肌的远端半部分。不关闭两个缺损，然后将肌肉置于膀胱和阴道之间，在两个缺损的边缘周围使用单根缝线固定。手术由泌尿科医生和整形外科医生组成的团队进行。
所有 3 名患者均成功接受治疗。随访 5-8 年，无症状复发。
这种改良的手术技术提供了血供良好、未受辐射的组织，可作为基于下腹动脉的间置物瓣，用于治疗放射性膀胱阴道瘘。该技术可以阻塞瘘管，而无需关闭膀胱和阴道的黏膜缺损。
