Ostad M, Uzzo R G, Coleman J, Young G P
James Buchanan Brady Department of Urology, New York Hospital--Cornell University Medical Center, New York 10021, USA.
Urology. 1998 Jul;52(1):123-6. doi: 10.1016/s0090-4295(98)00120-4.
The aim of this paper is to describe a simple, fast, and effective method for repair of difficult vesicovaginal fistulae by means of a free bladder mucosal graft. Six patients with high, large, multiple, or recurrent vesicovaginal fistulae were treated using a free bladder mucosal graft. Three patients underwent "early" repair (less than 3 months from time of injury) and 3 "late" repair (more than 6 months from time of injury). Via a suprapubic cystotomy, the mucosa of the fistulous tract was debrided without any attempt to excise the tract or close the bladder or vaginal defects. A free bladder mucosal graft was harvested from an unaffected portion of the bladder and placed over the fistulous tract, and mucosal approximation was made using interrupted 5-0 chromic stay sutures. The donor urothelial defect was allowed to re-epithelialize. A Foley catheter, suprapubic tube, and vaginal packing were left in place. Five patients noted an immediate result, with no evidence of leakage, and the suprapubic tube was removed by week 3. One patient required prolonged catheter drainage, and the tube was successfully removed by week 6. This patient had undergone irradiation. All patients remain dry at follow-up, which ranges from 2 to 6 years. We describe a simple and effective method for transabdominal vesicovaginal fistula repair, involving minimal mobilization, decreased dissection, and no need for rotational or interposition flaps, obviating the need to open the peritoneum. A free bladder mucosal graft can be used regardless of the individual anatomy or proximity to the ureteral orifices, because it can easily be tailored. This technique represents an important repair of difficult, recurrent, or multiple vesicovaginal fistulae.
本文旨在描述一种通过游离膀胱黏膜移植修复复杂膀胱阴道瘘的简单、快速且有效的方法。6例患有高位、大型、多发或复发性膀胱阴道瘘的患者接受了游离膀胱黏膜移植治疗。3例患者接受了“早期”修复（受伤后不到3个月），3例接受了“晚期”修复（受伤后超过6个月）。经耻骨上膀胱切开术，对瘘管的黏膜进行清创，不试图切除瘘管或闭合膀胱或阴道缺损。从膀胱未受影响的部分获取游离膀胱黏膜移植片，放置在瘘管上，并用间断5-0铬制保留缝线进行黏膜对合。供体尿路上皮缺损任其重新上皮化。留置Foley导尿管、耻骨上引流管和阴道填塞物。5例患者术后立即见效果，无漏尿迹象，耻骨上引流管在第3周拔除。1例患者需要延长导管引流时间，该引流管在第6周成功拔除。该患者曾接受过放疗。所有患者在随访期间（2至6年）均保持干燥。我们描述了一种简单有效的经腹膀胱阴道瘘修复方法，该方法涉及最少的组织游离、减少的解剖操作，无需旋转或插入皮瓣，无需打开腹膜。无论个体解剖结构或与输尿管口的接近程度如何，均可使用游离膀胱黏膜移植片，因为它易于裁剪。该技术是修复复杂、复发或多发膀胱阴道瘘的一种重要方法。
