Introduction. Radial vesicovaginal fistulas are one of the most difficult problems of urogynecology, despite the fact that modern technologies make it possible to personalize the use of radiation therapy. Standard surgical techniques in the treatment of such patients are ineffective. The search for alternative surgical solutions can improve the results of treatment of patients with radial fistulas and microcystis.
Study objective. To compare the effectiveness of augmentation ileocystoplasty and two-stage surgical treatment, represented by expanding intestinal cystoplasty in combination with the use of a Martius or Martius-Symmonds flaps.
Materials and methods. The study included 8 patients. The first group included 4 patients who underwent laparotomy, augmentation ileocystoplasty. In 3 patients relapsed fistulas were closed with vaginal access using a Martius flap a few months later. The second group included 4 patients who underwent expanding intestinal cystoplasty by laparotomy, with further formation of Martius or Martius-Symmonds flaps by perineal access and moving them into the pelvic cavity for fixation from the abdominal cavity.
Results. The average duration of the operation in the first group was 337.5 minutes, in the second group – 470 minutes. The patients of the first group had no complications of the III-V groups according to Clavien-Dindo. Natural urination was eventually recovered in all patients. In 2 patients of the second group, postoperative complications were recorded: in 1 patient – complication of group IIIa according to Clavien-Dindo – marginal necrosis of the skin flap after abdominoplasty, which required stage necrectomy and secondary skin sutures, in another 1 patient – complication of group IIIb according to Clavien-Dindo – dynamic intestinal obstruction, which required relaparotomy and nasointestinal intubation. There were no relapses of vesicovaginal fistulas. After urination was restored, all patients retained the urge to urinate.
Conclusion. The proposed two-stage operation allows not only to eliminate the vesicovaginal fistulas, but also to increase the capacity of the bladder, restore voluntary urination.