[Cure of complex post-irradiation uro-genital fistulae]

The authors report two cases of complex radiation induced urogenital fistulae (vesicovaginal and combined rectovaginal), which were closed successfully at the second attempt with complete restitution of bladder function, without any urinary diversion using colpocleisis in one patient. They mention the necessity of bringing a new source of blood supply into the fistula repair area. Then, they review the different extensive procedures used to ensure this result: small bowel graft, omentopexy to reinforce the suture lines, fibroadipose tissue from the labia majora (Martius' operation). Lastly, basedow their experience and a review of the literature, they propose a therapeutic strategy based on a transperitoneovesical approach with the combined used of isolated small bowel and omental pedicle graft.