Mohseni Mohammad G, Hosseini Seyed R, Alizadeh Farshid, Gooran Shahram, Valikhani Nadia
Department of Urology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.
Adv Biomed Res. 2012;1:77. doi: 10.4103/2277-9175.102984. Epub 2012 Oct 31.
To investigate the effectiveness of bladder mucosal autograft for the treatment of vesicovaginal fistulae.
Between March 2005 and June 2011, 21 patients with a single vesicovaginal fistula above the trigone, not involving the ureters, underwent surgery. Bladder was approached extraperitoneally and opened in the midline. The mucosa around the fistula was incised and inverting sutures were placed over the fistula opening. The mucosal defect was covered by a free mucosal graft from the edge of cystotomy incision.
After catheter removal at 2 weeks, 18 patients (85 %) remained dry while one patient experienced urge incontinence, which resolved in a few days and another one still had urine leakage (although less than before the operation) that improved after another 3 weeks of bladder drainage. Only in one patient, the operation failed.
Short duration of hospitalization, simplicity of the procedure, avoidance of extensive bladder dissection, and extraperitoneal nature of the operation, along with a high success rate are the advantages of this procedure. This technique could be recommended for single fistulae not involving the ureters and not secondary to malignancies.
探讨膀胱黏膜自体移植治疗膀胱阴道瘘的有效性。
2005年3月至2011年6月，21例膀胱三角区以上单发膀胱阴道瘘且未累及输尿管的患者接受了手术。经腹膜外途径进入膀胱并在中线切开。切开瘘口周围的黏膜，在瘘口处放置荷包缝合。膀胱切开切口边缘的游离黏膜移植物覆盖黏膜缺损。
术后2周拔除导尿管后，18例患者（85%）保持干燥，1例患者出现急迫性尿失禁，数日后缓解，另1例仍有漏尿（尽管比术前减少），膀胱引流3周后有所改善。仅1例患者手术失败。
住院时间短、手术操作简单、避免广泛的膀胱解剖、手术的腹膜外性质以及高成功率是该手术的优点。对于未累及输尿管且非恶性肿瘤继发的单发瘘，可推荐采用该技术。
