title: Interposition flaps in vesicovaginal fistula repairs can optimize cure rate.
abstract: OBJECTIVE
  To report the result of vesicovaginal fistula (VVF) repair using the transabdominal approach with flap interposition.
  
  
  METHODS
  Between January 2004 and the end of 2011, operative reports data and medical records systems were reviewed for all VVF cases operated and followed in Urology Department. All patients had detailed history taking and physical exam followed by intravenous pyelograms or contrast CT abdomen and pelvis to rule out the presence of ureterovaginal fistulae. We utilized the infra-umbilical transabdominal approach and transpose an omental flap or peritoneal flap between the vaginal and bladder incisions in all cases.
  
  
  RESULTS
  Twenty-six patients with an average age of 46 years were managed for VVF through transabdominal route with interposition of omental flap or peritoneal flap by a single surgeon. Twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and twelve cases of VVF were secondary to lower segment cesarean section (LSCS) and 14 cases following hysterectomies. We had 16 complex VVF with 4 cases that failed the previous abdominal repair outside the hospital. More than 95% (25) of our patients were cured at the first attempt, with no recurrence at a mean follow-up of 28.6 (range 8-73) months.
  
  
  CONCLUSIONS
  Successful repair of VVF depends on the experience of the surgeon and adhering to basic surgical principles. Very high success rate was seen when flap interposition had been used.
authors: Department of Urology, King Faisal Specialist Hospital and Research Centre, Alfisal University, Riyadh 11211, Kingdom of Saudi Arabia.
authors: Waleed Mohammad
authors: WM
authors: Altaweel
authors: Emad
authors: E
authors: Rajih
authors: Waleed
authors: W
authors: Alkhudair
keywords: Incontinence; omental flap; vesicovaginal fistula