Buccal Mucosal Graft as a Second Layer in the Vaginal Repair of Vesicovaginal Fistulas.

Abstract

Objective: Vesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The most common cause of VVF is hysterectomy, while less common causes include obstetric trauma and pelvic surgery. Most cases require surgical intervention. Although various techniques have been described for the management of VVF, none has been considered the gold standard of management. In this study, we describe our technique using buccal mucosal graft (BMG) as a second layer in the repair of VVF through a vaginal approach.

Methods: A total of 10 patients underwent surgery between May 2023 and December 2023. Patients were scheduled for follow-up 3 weeks after surgery or earlier for any new symptoms of urinary incontinence, overactive bladder, or dysuria. Before catheter removal, a CT cystogram was performed to confirm fistula closure. Additional follow-up visits were scheduled at 3-6 months after repair to assess outcome.

Results: Ten patients with a mean age of 35.7 ± 7.18 years were operated with the described technique. All patients had no recurrence of the fistula at the 6-month follow-up. None of them had additional morbidity due to the procedure. There were no post-operative complications.

Conclusions: Although the success rates of simple VVF are very high, the interposition of a tissue graft between the bladder and the vagina is required in the treatment of VVF, especially in those recurrent, large complex and radiation-induced fistulas. The buccal mucosa has a thick epithelium that provides strength to the graft and a thin submucosa that is important for revascularization, so its use as a second layer in VVF repair may be beneficial. Its harvesting is a relatively simple procedure. It is not time-consuming and is associated with low morbidity compared to Martius flap harvesting.