Abstract | OBJECTIVE: 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.
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Authors | J Leissner, P Black, D Filipas, M Fisch, R Hohenfellner |
Journal | Gynecologic oncology
(Gynecol Oncol)
Vol. 78
Issue 3 Pt 1
Pg. 356-60
(Sep 2000)
ISSN: 0090-8258 [Print] United States |
PMID | 10985894
(Publication Type: Journal Article)
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Copyright | Copyright 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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