Management of Urethrovaginal Fistula and Stress Urinary Incontinence Using a Martius Flap and Laparoscopic Artificial Urinary Sphincter Implantation.

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.