title: The urachal flap: a previously unreported tissue flap in vesicovaginal fistula repair.
abstract: OBJECTIVE
  Tissue interposition is an important part of vesicovaginal fistula (VVF) repair that has been shown to improve success rates. The most common interpositional flap used during a transabdominal VVF repair is the omental flap; however, in some cases, it cannot be used. The urachus is a well-vascularized tissue that is easily mobilized for interposition. We describe our experience using a urachal flap in VVF repair.
  
  
  METHODS
  Patients undergoing VVF repair at our center were identified, and a retrospective chart review was performed. Patients who underwent a transabdominal repair with interposition of a urachal flap were included.
  
  
  RESULTS
  Thirteen patients were identified between 2005 and 2009. All were evaluated with a history, physical, upper and lower tract imaging, and cystoscopy. Median patient age was 49 years (range, 31-88 years). Fistula etiology was hysterectomy in 11 and prolapse repair in 2. Five patients presented with recurrent fistulas having failed previous repair. Of 13 patients, 12 had successful repairs with our described technique, including 4 patients who failed previous repairs. There was no recurrence of fistula after median follow-up of 6 months (range, 2 weeks to 4 years). Two patients had preoperative and postoperative complaints of stress urinary incontinence that was mild and did not require surgery.
  
  
  CONCLUSIONS
  Vesicovaginal fistulas can be a difficult challenge for the reconstructive surgeon. The urachal flap is a well-vascularized tissue flap that can be easily mobilized and interposed for VVF repair. Of 13 patients in this series, 12 were successfully repaired using this technique. We feel that further evaluation and usage of this tissue flap are indicated.
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA 23462, USA. franciejames@gmail.com
authors.forename: Mary Henderson
authors.initials: MH
authors.lastname: James
authors.forename: Britton E
authors.initials: BE
authors.lastname: Tisdale
authors.forename: Timothy O
authors.initials: TO
authors.lastname: Davies
authors.forename: Kurt A
authors.initials: KA
authors.lastname: McCammon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D014497:Urachus / Q000637:transplantation*; D014719:Vesicovaginal Fistula / Q000601:surgery*