Serinçay Halime, Güler Hayrullah Uğur, Ulubayram Kezban, Mangır Naşide
Bioengineering Division, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey.
Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Ther Adv Urol. 2023 Jun 26;15:17562872231182217. doi: 10.1177/17562872231182217. eCollection 2023 Jan-Dec.
Research on the use of tissue interposition flaps (TIFs) in vesicovaginal fistulae (VVF) repair is a broad area where a very wide range of natural and synthetic materials have been used. The occurrence of VVF is also diverse in the social and clinical settings, resulting in a parallel heterogeneity in the published literature on its treatment. The use of synthetic and autologous TIFs in VVF repair is not yet standardized with a lack of the most efficacious type and technique of the TIF.
The aim of this study was to systematically review all synthetic and autologous TIFs used in the surgical repair of VVFs.
In this scoping review, the surgical outcomes of autologous and synthetic interposition flaps used in VVF treatment meeting the inclusion criteria were determined. We searched the literature using Ovid MEDLINE and PubMed databases between 1974 and 2022. Study characteristics were recorded, and data on the change in fistulae size and location, surgical approach, success rate, preoperative patient evaluation and outcome evaluation were extracted from each study independently by two authors.
A total of 25 articles that met the inclusion criteria were included in the final analysis. A total of 943 and 127 patients who had received autologous and synthetic flaps, respectively, were included in this scoping review. The fistulae characteristics were highly variable with regard to their size, complexity, aetiology, location and radiation. Outcome assessments of fistulae repair in included studies were mostly based on symptom evaluation. Physical examination, cystogram and methylene blue test were the methods in order of preference. Postoperative complications, such as infection, bleeding, donor site, pain, voiding dysfunction and other complications, were reported in patients after fistulae repair in all included studies.
The use of TIFs in VVF repair was common especially in complex and large fistulae. Autologous TIFs appear to be the standard of care at the moment, and synthetic TIFs were investigated in prospective clinical trials in a limited number of selected cases. Evidence levels of clinical studies evaluating the effectiveness of interposition flaps were overall low.
关于组织插入瓣（TIFs）在膀胱阴道瘘（VVF）修复中的应用研究是一个广泛的领域，其中使用了各种各样的天然和合成材料。VVF的发生在社会和临床环境中也各不相同，导致其治疗的已发表文献存在类似的异质性。在VVF修复中使用合成和自体TIF尚未标准化，缺乏最有效的TIF类型和技术。
本研究的目的是系统评价所有用于手术修复VVF的合成和自体TIF。
在本范围综述中，确定了符合纳入标准的用于VVF治疗的自体和合成插入瓣的手术结果。我们使用Ovid MEDLINE和PubMed数据库在1974年至2022年期间检索文献。记录研究特征，两位作者分别从每项研究中独立提取瘘管大小和位置的变化、手术方法、成功率、术前患者评估和结果评估的数据。
共有25篇符合纳入标准的文章纳入最终分析。本范围综述共纳入了分别接受自体瓣和合成瓣治疗的943例和127例患者。瘘管特征在大小、复杂性、病因、位置和放疗方面差异很大。纳入研究中对瘘管修复的结果评估大多基于症状评估。体格检查、膀胱造影和亚甲蓝试验是首选方法。所有纳入研究均报告了瘘管修复术后患者出现的术后并发症，如感染、出血、供区、疼痛、排尿功能障碍和其他并发症。
TIFs在VVF修复中应用普遍，尤其是在复杂和大型瘘管中。目前自体TIF似乎是治疗的标准，合成TIF仅在少数选定病例的前瞻性临床试验中进行了研究。评估插入瓣有效性的临床研究的证据水平总体较低。
