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REPAIR OF URINARY TRACT FISTULAS WITH BULBOCAVERNOSUS MYOCUTANEOUS FLAPS

From the Divisions of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, Uniformed Services University School of Medicine, Bethesda, Maryland; Division of Gynecologic Oncology, Naval Hospital, Bethesda, Maryland; Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D.C.;and Department of Obstetrics and Gynecology, Naval Hospital, Charleston, South Carolina

Abstract

Urinary tract fistulas resulting from severe trauma or pelvic irradiation are often associated with extensive tissue loss, scar formation, and fibrosis. Two cases, one with a urethrovaginal fistula secondary to trauma and one with a vesicovaginal fistula secondary to irradiation, are presented. In neither case could the bladder, urethra, or vagina be repaired primarily. Using a bulbocavernosus myocutaneous "island" flap, the fistulas were successfully repaired. The anatomy of the graft and the operative procedure are described. This new procedure should be considered in urinary tract fistulas in which there is extensive tissue loss and scarring.