Martius procedure revisited for urethrovaginal fistula

• Main Authors: N P Rangnekar, N Imdad Ali, B S Patil, H R Pathak
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2000-01-01
• Series: Indian Journal of Urology
• Subjects: Martius Procedure; Urethrovaginal Fistula
• Online Access: http://www.indianjurol.com/article.asp?issn=0970-1591;year=2000;volume=17;issue=1;spage=16;epage=19;aulast=Rangnekar
• ISSN: 0970-1591; 1998-3824

Background: Urethrovaginal fistula is a dreadful com-plication of obstetric trauma due to prolonged labour or obstetric intervention commonly seen in developing coun-tries. Due to prolonged ischaemic changes, the fistula is resistant to healing. The strategic location of the fistula leads to postoperative impairment of continence mecha-nism. 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 re-current fistulae while I patient had multiple fistulae. Pa-tients 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 Intrin-sic Sphincter Deficiency (ISD). In case of recurrent fistu-lae the success rate of anatomical repair was 0% compared to 83.33% with Martius procedure. Conclusions: Martius procedure has shown much bet-ter overall cure rate compared to anatomical repair be-cause - 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 sur-face for epithelialization and, d) helps to maintain conti-nence. Hence we recommend Martius procedure as a surgical modality for the treatment of urethrovaginal fis-tula.