The fistula was then excised and closed in a standard manner. He did mention on the CT scan pre operatively there was a plane demonstrated. Once the fistula was closed an omental flap was identified and placed between the vaginal flap and the neobladder. A Foley catheter was left in the bladder afterward. The patient was able to pass a trial of void successfully.
Audience questions were then taken. Dr. Blavais asked about difficult reach high fistulas and Dr. Zimmern recommends placing the patient is a steep Trendelenburg and using a long tip bovie. Although this was not a radiation fistula, an inverted T flap was recommended by another attendee.
Dr. Zimmern mentions if there was no omentum available for the flap he could bring down a Martius flap.
In summary, Dr. Zimmern’s approach to a non-radiated neobladder vaginal fistula used the same principles as a vesicovaginal fistula repair.
Presented by: Philippe E. Zimmern, MD, FACS, FPMRS, Professor in the Department of Urology at UT Southwestern Medical Center and Director of the Bladder and Incontinence Treatment Center