Journal of minimally invasive gynecology · 2026
Management of Urethrovaginal Fistula and Stress Urinary Incontinence Using a Martius Flap and Laparoscopic Artificial Urinary Sphincter Implantation.
СтатьяНазвание и аннотация: Перевод в очереди
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Sanchez Gallego Maria Dolores, Rubia Escribano Alba, Carracedo Calvo David, De La Morena Gallego Jose Manuel
Аннотация
OBJECTIVE: To present the diagnosis and management of a patient with an iatrogenic urethrovaginal fistula and the subsequent management of stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) through laparoscopic artificial urinary sphincter (AUS) implantation.
SETTING: Secondary care center specialized in minimally invasive reconstructive urogynecology.
PARTICIPANTS: A 69-year-old woman with an iatrogenic urethrovaginal fistula following transobturator suburethral sling failed surgery for SUI, who subsequently developed ISD after fistula repair.
INTERVENTION: Diagnostic confirmation of the urethrovaginal fistula and surgical repair via excision, urethrorrhaphy, and interposition of a right bulbocavernosus Martius flap through a submucosal tunnel for suburethral positioning prior to colporrhaphy [1-7].
CONCLUSIONS: We report the first case of sequential urethral fistula repair followed by laparoscopic AUS implantation. Iatrogenic urethrovaginal fistulas require a complex surgical approach. The Martius flap is an effective technique for reducing recurrence, particularly in urethral, complex fistulas, or irradiated tissues. Laparoscopic AUS implantation appears to be a feasible option for treating SUI secondary to ISD after urinary fistula repair, with encouraging functional outcomes. VIDEO ABSTRACT.
SETTING: Secondary care center specialized in minimally invasive reconstructive urogynecology.
PARTICIPANTS: A 69-year-old woman with an iatrogenic urethrovaginal fistula following transobturator suburethral sling failed surgery for SUI, who subsequently developed ISD after fistula repair.
INTERVENTION: Diagnostic confirmation of the urethrovaginal fistula and surgical repair via excision, urethrorrhaphy, and interposition of a right bulbocavernosus Martius flap through a submucosal tunnel for suburethral positioning prior to colporrhaphy [1-7].
CONCLUSIONS: We report the first case of sequential urethral fistula repair followed by laparoscopic AUS implantation. Iatrogenic urethrovaginal fistulas require a complex surgical approach. The Martius flap is an effective technique for reducing recurrence, particularly in urethral, complex fistulas, or irradiated tissues. Laparoscopic AUS implantation appears to be a feasible option for treating SUI secondary to ISD after urinary fistula repair, with encouraging functional outcomes. VIDEO ABSTRACT.