Comparison of Transvaginal Repair of Vesicovaginal Fistula with and without Martius Flap

Abstract

Background: Different approaches and techniques have been adopted to repair Vesicovaginal Fistula (VVF) successfully. However, role of tissue interposition in success of VVF repair is still controversial. Objective: To compare the outcomes of transvaginal repair of Vesicovaginal fistula (VVF) with and without martius flap in terms of success rate and recurrence. Study Design: Randomized control study. Settings: Department of Urology Lahore General Hospital, Lahore Pakistan. Duration: One year and six months from January 01, 2019 to June 30, 2020. Methodology: Total 40 patients with VVF were included in the research, malignant, radiation induced and complex fistula are excluded. 40 patients of transvaginal repair of VVF, split into two groups, randomized by serial number technique each consisting of 20, group A repaired with martius flap and group B with simple repair without martius flap. After 2, 4 and 8 weeks all the patients were assessed for recurrence or any other complication. The data was collected in a specially designed proforma. Results: 40 patients fulfilling the inclusion criteria were included, 20 patients in each group. Mean age of group A patients was 36.70±5.16 and of that group B was 37.10±4.58. 33 (85.5%) patients have supra-trigonal fistula, while 7(14.5%) had trigonal fistula and mean fistula size was 1.96cm ±1.0. The success rate was 100% (20/20) in group A, while in group B, 95 % (19/20) with recurrence in one case. Chi square analysis was employed for comparison of adequacy of both the techniques. p-value was found to be 0.311 which suggests that the difference between the efficacies of two techniques was not statistically significant. Conclusion: Both the techniques of transvaginal repair of simple benign Vesicovaginal fistula are successful with equal success rate in martius inter positional flap repair and simple bilayer repair without flap.