Application of bulbospongiosus muscle flap tamponade combined with vaginal occlusion in the repair of complex urinary fistula following radiotherapy: a surgical technique.

Vesicovaginal fistula (VVF) after radiotherapy is a serious complication that occurs after radiotherapy for pelvic malignant tumors. Traditional nephrostomy greatly affects patients' quality of life, restricting their daily activities. It may also cause side injuries and bleeding due to large surgical trauma, which made the widespread adoption of this surgery method difficult. This article aims to explore the application of bulbospongiosus muscle flap packing combined with vaginal closure in complex VVF after radiotherapy. We presented a case where a patient with stage IIIB cervical squamous cell carcinoma developed abnormal vaginal discharge two years after full-dose chemoradiotherapy. The patient was diagnosed with VVF and conservative treatment was ineffective. After the assessment of no tumor recurrence, repair using bulbospongiosus muscle flap tamponade combined with vaginal closure was performed. The surgeries were successfully completed. The operation time was 96 min and the bleeding volume was 69 mL. The catheter was retained for two weeks after operation. The patient was followed up for 18 months after the operation. There was no vaginal discharge; the bladder mucosa was well repaired; the bladder capacity was about 300 mL; there were no symptoms of frequent urination and urgent urination; and there was no hydronephrosis of the renal pelvis. Vaginal packing with bulbospongiosus muscle flap combined with vaginal sealing can be used as a repair technique for complex fistulas in the perineal region. This is a surgical method that is convenient for obtaining materials, simple to operate, minimally invasive, and delivers clear therapeutic results.