A case of vesico-vaginal fistula repair with Martius flap after radical hysterectomy and postoperative radiation therapy for cervical cancer

Abstract

Vesico-vaginal fistula is a rare condition that is caused primarily by iatrogenic injury in developed countries. A fistula induced by radiation is more difficult to repair because of tissue weakness. Our patient was a 45-year old female who complained of stress urinary incontinence after radical hysterectomy with postoperative radiation for cervical cancer. At 13 months after surgery, a fistula draining urine was found 1 cm from the vaginal stump. Cystoscopy revealed reddish mucosa in front of the right ureteral orifice. We diagnosed the patient with a vesico vaginal fistula. After an 11-month follow-up, surgical repair was performed via a transvaginal approach with a Martius flap derived from the labial fat pad. At one year and six months after surgery, there was no recurrence of fistula or cervical cancer.