Fibrin glue versus martius flap interpositioning in the repair of complicated obstetric vesicovaginal fistula. A prospective multi-institution randomized trial.
OBJECTIVE
To examine the efficacy of using fibrin glue (FG) as an interpositioning layer in the repair of complicated vesioovaginal fistulae (VVFe) as compared to the classical repair using martius flaps (Ml').


METHODS
The study was conducted in 3 African institutions. Forty female patients with complicated VVFs were randomized into 2 groups. Group A were repaired anatomically using FG as interpositioning layer. Group B were repaired anatomically using MF as an interpositioning layer. FG used in this study was prepared from patients own blood. Complicating factors were recurrence, local moderate to severe fibrosis, fistula location involving the bladder neck, and or size of the fistola being more than 1.5 cm in its largest diameter. Patients were evaluated after 2 weeks, one month and 3 months postoperatively.


RESULTS
Thirty eight patients were evaluable as 2 patients, one from each group, lost to follow-up. Patient demographics were not different between the two study groups. The frequency of occurrence of complicating factors was not different between the 2 groups. Thirteen of group A and eleven from group B were rendered dry and that was maintained for as long as they were followed-up. The difference in the outcome was not statistically significant.


CONCLUSIONS
The use of FG as an interpositioning layer during the vaginal anatomical repair of complicated VVF appears to be of great value as an alternative to the use of MF interpositioning. Decreasing the operative time and adding simplicity to the already complicated procedure are additional values of using this procedure. Neurourol. Urodynam. 28:438-441, 2009. (c) 2009 Wiley-Liss, Inc.
Safan
Ahmed
A
Urology Department, Ain Shams University, Cairo, Egypt.
Shaker
Hassan
H
Abdelaal
Abdalla
A
Mourad
M Sherif
MS
Albaz
Mohammed
M
D000293:Adolescent; D000328:Adult; D000349:Africa; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005355:Fibrosis; D006801:Humans; D007744:Obstetric Labor Complications / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D011446:Prospective Studies; D012008:Recurrence; D013524:Surgical Flaps / Q000009:adverse effects; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives