[Our experience in the Martius method of closing the vesicovaginal fistula]

Sometimes after delivery, gynecological or other surgeries, radiological therapy, or destructions of vesico-vaginal septum due to the tumor or trauma, the unnatural communication between the bladder and vagina occurs. Those are fistulas that occur after the delivery (tocogenic) caused by the prolonged delivery or some obstetrics operations. Some fistulas are high, coming from the fundus of the bladder, medium, if they come just behind the trigonum of the bladder, and low, if they are in the level of trigonum and the neck of the bladder. The purpose of this paper is to show the operative technique of elimination of medium and low vesicovaginal fistula and the results of the treatment. Material and method The elimination of the vesicovaginal fistula by original Martius technique is done through vagina. The catheter is inserted through the fistula (figure 1). Than the mucosis of the vagina is cut around the fistula and the vaginal wall is separated from the bladder. The catheter is pulled out and the fistula on the bladder is sown with resorptive stitches. Than the labia maiora nearer to the fistula is cut along from Mons Veneris to the middle and the lipoid tissue is taken with vascular pedicle (figure 2). This tissue is put between the bladder and the vagina and fixed with resorptive stitches. After that the vagina is sown by single stitches. The labia maiora that was cut is also sown by single stitches (figure 3). Than the catheter is inserted in the bladder that should stay there for four weeks. This is the method we used to make surgery in twenty patients with vesicovaginal fistula. The first one had the fistula as the result of the Caesarean section. She was operated twice through the bladder without success. The second patient was a fourteen years old girl that cut herself on the glass and damaged anal sfincter, rectum, vagina and the bladder. The fistula appeared later in the level of trigonum of the bladder. The other eighteen patients got fistula after hysterectomy. All patients were treated as described above and fistulas disappeared. The first patient had another baby a year after the operation by Caesarean section. The other patients have regular miction (figure 4 and 5). Discussion and the conclusion Vesicovaginal fistula are serous complications, for the patients and for the doctors. The only treatment of the vesicovaginal fistula is surgical. If any damage of the bladder occurs during any operation it should be treated immediately, otherwise the fistula will appear. The treatment depends of the localization of the fistula. Low fistulas and some medium and urethrovaginal fistulas should be approached through vagina and according to our experience Martius's method is very efficient. The only important thing is when the fistula is detected to wait at least for two or three months for the fistula to "consolidate" and also to cure the infection.