USE OF A FREE BLADDER MUCOSAL GRAFT FOR SIMPLE REPAIR OF VESICOVAGINAL FISTULAS

The aim of this paper is to describe a simple, fast, and effective met hod for repair of difficult vesicovaginal fistulae by means of a free bladder mucosal graft. Six patients with high, large, multiple, or rec urrent vesicovaginal fistulae were treated using a free bladder mucosa l graft. Three patients underwent ''early'' repair (less than 3 months from time of injury) and 3 ''late'' repair (more than 6 months from t ime of injury). Via a suprapubic cystotomy, the mucosa of the fistulou s tract was debrided without any attempt to excise the tract or close the bladder or vaginal defects. A free bladder mucosal graft was harve sted from an unaffected portion of the bladder and placed over the fis tulous tract, and mucosal approximation was made using interrupted 5-0 chromic stay sutures. The donor urothelial defect was allowed to re-e pithelialize. A Foley catheter, suprapubic tube, and vaginal packing w ere left in place. Five patients noted an immediate result, with no ev idence of leakage, and the suprapubic tube was removed by week 5. One patient required prolonged catheter drainage, and the tube was success fully removed by week 6. This patient had undergone irradiation. All p atients remain dry at follow-up, which ranges from 2 to 6 years. We de scribe 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 regar dless of the individual anatomy or proximity to the ureteral orifices, because it can easily be tailored. This technique represents an impor tant repair of difficult, recurrent, or multiple vesicovaginal fistula e. (C) 1998, Elsevier Science Inc. All rights reserved.