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Vaginal reconstruction using the bladder and/or rectal walls in patients with radiation-induced fistulas.

AbstractOBJECTIVE:
In irreparable or recurrent vesicovaginal fistulas and cloacal defects following high-dose irradiation therapy for gynecological malignancies, urinary diversion is the last resort to achieve a socially acceptable solution. In a select group of young and tumor-free patients, additional vaginal reconstruction may be indicated. Multiple operative procedures are available, but the results are often disappointing in the previously irradiated area.
MATERIALS AND METHODS:
In six such patients with large radiogenic vesicovaginal defects (n = 5) or a cloacal fistula (n = 1), a continent reservoir using the transverse colon with an umbilical stoma was performed. At the end of the operation, the bladder was incorporated into a neovagina by incising the urethra, anterior vaginal wall, and the posterior bladder wall with electrocautery from the urethral meatus to the dome of the fistula.
RESULTS:
No postoperative complications related to the vaginal reconstruction occurred. After a mean follow-up of 4.7 years, all patients had a capacious vagina and a wide introitus; the neovagina measured a mean of 18 cm in length. Five patients with a partner reported a normal sexual life. No dyspareunia or discomfort from bladder or urethral mucosa during intercourse was reported.
CONCLUSIONS:
Following continent urinary diversion due to irreparable vesicovaginal fistulas, a neovagina can be created by simple dissection of the posterior bladder and anterior vaginal wall. When a colostomy is present, the neovagina can additionally be augmented with a bowel flap of the Hartmann stump or by incising the rectovaginal septum. The technique affords good functional and cosmetic results.
AuthorsJ Leissner, P Black, D Filipas, M Fisch, R Hohenfellner
JournalGynecologic oncology (Gynecol Oncol) Vol. 78 Issue 3 Pt 1 Pg. 356-60 (Sep 2000) ISSN: 0090-8258 [Print] United States
PMID10985894 (Publication Type: Journal Article)
CopyrightCopyright 2000 Academic Press.
Topics
  • Cloaca (radiation effects, surgery)
  • Female
  • Humans
  • Radiation Injuries (etiology, surgery)
  • Plastic Surgery Procedures (adverse effects, methods)
  • Rectum (surgery)
  • Urinary Bladder (radiation effects, surgery)
  • Urinary Diversion
  • Uterine Cervical Neoplasms (radiotherapy, surgery)
  • Vagina (radiation effects, surgery)
  • Vesicovaginal Fistula (etiology, surgery)

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