| ORIGINAL ARTICLE |
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| Year : 2000 | Volume
: 17
| Issue : 1 | Page : 16-19 |
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Martius procedure revisited for urethrovaginal fistula
NP Rangnekar, N Imdad Ali, BS Patil, HR Pathak
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
India
 Source of Support: None, Conflict of Interest: None  | Check |
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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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