title: The uses and outcomes of the Martius fat pad in female urology.
abstract: OBJECTIVE
  To assess the indications, morbidity, efficacy and outcomes of Martius fat pad (MFP) interposition in reconstructive female urology.
  
  
  METHODS
  Data on 159 women with MFP interposition as part of their primary procedure between 2 September 2005 and 2 July 2015 were prospectively collected. Patient demographics and the indications for MFP interposition along with the outcomes of their primary procedures and short- and long-term complications related to the MFP, along with patient reported perception of post-operative appearance, were noted.
  
  
  RESULTS
  The main indications for MFP interposition were urethral diverticulum excision (74), vaginal repair of vesicovaginal fistula (VVF) (43), removal and repair of urethral erosion of mid-urethral tape (MUT) (24), female urethroplasty for stricture (12), vaginal closure of bladder neck for complex end-stage stress urinary incontinence (USUI) (4) and as a MUT wrap for protection of urethra and vagina in women with fragile urethras (2). The majority of patients (127 or 79 %) rated the post-operative appearance of their labia as good or excellent. Only 1 patient (0.6 %) felt the post-operative appearance was unsatisfactory. There were 2 post-harvest labial haematoma (1.25 %), 1 labial wound infection in an overweight diabetic patient (0.6 %) and no other significant short- or long-term complications.
  
  
  CONCLUSIONS
  MFP interposition is associated with good cosmesis and a very low complication rate (<2 %). It appears to lower new onset post-procedure USUI, prevent erosion in the 'fragile' urethra and improve outcomes following repair of post-surgery VVF/UVF. MFP is a versatile and effective tool in the female urologists' armamentarium.
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK. sachmalde@gmail.com.
authors.forename: Sachin
authors.initials: S
authors.lastname: Malde
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Spilotros
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Mahreen
authors.initials: M
authors.lastname: Pakzad
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ockrim
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: P Julian
authors.initials: PJ
authors.lastname: Shah
authors.affiliation: Department of Urology, University College Hospital, London, NW1 2PG, UK.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Greenwell
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014522:Urethral Diseases / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*; D014844:Vulva; D055815:Young Adult
keywords: Diverticulum; Fistula; Incontinence; Martius fat pad