The use of the Rectus abdominis muscle to suspend the bladder in the treatment of uretero-vaginal fistulae.

This study evaluates a new and simpler technique for suspending the bladder during uretero-neocystostomy, using the posterior surface of the Rectus abdominis muscle rather than an vesico-psoas hitch. The technique was employed in six consecutive patients who presented with ureteric injuries following hysterectomy or caesarean section. Each patient was fully evaluated preoperatively, and the results of surgery evaluated after three months in five out of six women. All the patients were Zulu women who had sustained injuries to the lower five centimetres of a ureter at hysterectomy or caesarean section. This study was conducted in the obstetric and gynaecological unit of Eshowe Hospital, a 460 bed sub-regional hospital in northern KwaZulu Natal. The technique described in this paper proved to be easy to perform. Every patient was continent following surgery. All those who returned for follow up had normal drainage of the affected ureter. We conclude that this is a useful alternative to vesico-psoas hitch for suspending the bladder during uretero-neocystostomy.