title: Application of small intestinal submucosa graft for repair of complicated vesicovaginal fistula: a pilot study.
abstract: OBJECTIVE
  Vesicovaginal fistula is a socially debilitating problem with important psychological and medicolegal implications. Complicated fistulas include large fistulas or those with failed prior repair attempts. The key to successful closure of such fistulas is the use of adjuncts such as a Martius, peritoneal or omental flap. Small intestinal submucosa is an acellular collagen matrix graft that is nonimmunogenic, biodegradable and ready to use off the shelf. We evaluated small intestinal submucosa as an interposition patch during complicated vesicovaginal fistula repair.
  
  
  METHODS
  A total of 23 women with a mean age of 33.5 years who had a complicated vesicovaginal fistula were enrolled in this clinical trial. Complicating factors were failed primary repair in 9 cases, excessive perifistulous scarring in 4 patients and a fistula 1.5 cm or greater in the remainder. Transvaginal repair was done in 7 low fistula cases and transabdominal repair was done in the remainder with a high fistula. A small intestinal submucosa patch was interposed in all cases at classic abdominal or vaginal repair. All patients were evaluated 1, 3 and 6 months postoperatively.
  
  
  RESULTS
  All patients who underwent vaginal repair were dry during followup. Of the 16 women who underwent transabdominal repair 14 were dry. The overall success rate was 91.3%. No reported allergic or inflammatory reactions were documented.
  
  
  CONCLUSIONS
  Using small intestinal submucosa as an interposition layer at anatomical vaginal and/or transabdominal repair of complicated vesicovaginal fistulas seems to be a simple, feasible solution.
authors: Urology Department, Tanta University, Tanta, Egypt.
authors: Yasser A
authors: YA
authors: Farahat
authors: Mohamed A
authors: MA
authors: Elbendary
authors: Osama M
authors: OM
authors: Elgamal
authors: Ahmad M
authors: AM
authors: Tawfik
authors: Mohamed G
authors: MG
authors: Bastawisy
authors: Mohamed H
authors: MH
authors: Radwan
authors: Mohamed
authors: M
authors: Rasheed
mesh_terms: D000328:Adult; D000818:Animals; D001705:Bioprosthesis; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small; D010865:Pilot Projects; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000150:complications / Q000601:surgery*; D055815:Young Adult