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The Urachal Flap: A Previously Unreported Tissue Flap in Vesicovaginal Fistula Repair

James, Mary Henderson MD*; Tisdale, Britton E. MD; Davies, Timothy O. MD; McCammon, Kurt A. MD*

Female Pelvic Medicine & Reconstructive Surgery: May/June 2013 - Volume 19 - Issue 3 - p 148–151
doi: 10.1097/SPV.0b013e3182830b67
Original Articles

Objectives 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.

Tissue interposition is an important part of a successful VVF repair. We describe a variation of the traditional peritoneal flap using the urachus as tissue interposition in transabdominal VVF repair. Twelve of thirteen patients in our series were repaired successfully using the described method.

From the *Eastern Virginia Medical School, Norfolk, VA; †State University of New York at Buffalo, Buffalo, NY; and ‡McMaster University, Hamilton, Ontario, Canada.

Reprints: Mary Henderson James, MD, Eastern Virginia Medical School, 225 Clearfield Ave, Virginia Beach, Norfolk, Virginia, VA 23462. E-mail:

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins