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Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 16-19

Martius procedure revisited for urethrovaginal fistula

Department of Urology, Topiwala National Medical College & B. Y Nair Charitable Hospital, Mumbai, India

Correspondence Address:
N P Rangnekar
5, Radha Bhuvan, 176, L. J. Road. Shivaji Park, Dadar, Mumbai - 400 028
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Source of Support: None, Conflict of Interest: None

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Background: Urethrovaginal fistula is a dreadful com­plication of obstetric trauma due to prolonged labour or obstetric intervention commonly seen in developing coun­tries. Due to prolonged ischaemic changes, the fistula is resistant to healing. The strategic location of the fistula leads to postoperative impairment of continence mecha­nism. Anatomical repair was previously the commonest mode of surgical management, but was associated with a miserable cumulative cure rate ranging from 16-60%. Hence we tried to study the efficacy of Martius procedure in the management of urethrovaginal fistula. Material and Methods: We studied the outcome of 12 urethrovaginal fistulae, all caused by obstetric trauma, treated surgically with Martius procedure in 8 and with anatomical repair in 4, retrospectively. 9 patients had re­current fistulae while I patient had multiple fistulae. Pa­tients were followed up for the period ranging from 6 months to 4'/2 years for fistula healing, continence and postoperative complications like dvspareunia. Results: Cumulative cure rate ofMartius procedure was 87.5% with no postoperative stress incontinence, while fistula healing rate of anatomical repair was only 25% (I patient out of 4) which was also complicated by Intrin­sic Sphincter Deficiency (ISD). In case of recurrent fistu­lae the success rate of anatomical repair was 0% compared to 83.33% with Martius procedure. Conclusions: Martius procedure has shown much bet­ter overall cure rate compared to anatomical repair be­cause - a) it provides better reinforcement to urethral suture line, b) it provides better blood supply and lymph drainage to the ischaemic fistulous area, c) provides sur­face for epithelialization and, d) helps to maintain conti­nence. Hence we recommend Martius procedure as a surgical modality for the treatment of urethrovaginal fis­tula.

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