Comparative study between use of Buccal Mucosal Graft and Martius flap as A Second Layer in Vaginal Repair of complex Vesicovaginal Fistula: A prospective randomized trial

Background: The pathological communication that allows urine to flow into the vagina is called a vesicovaginal fistula (VVF), it is often associated with higher risks of repeated failed attempts as well the unsuccessful repair. Methods: we carried out this prospective randomized study on 16 cases of women with VVF, divided into two groups: The 1st group underwent trans-vaginal VVF repair with interposition of Buccal Mucosal Graft (BMG). The 2nd group underwent trans-vaginal VVF repair with interposition of Martius flap. Follow-up was done till 9 months after surgery for new symptoms of overactive bladder symptoms, urinary incontinence, dysuria. CT cystogram was performed to evaluate the fistula.Results: The mean operative time of the 2nd group was 71.37 ± 8.27 minutes which was longer than 1st group (66.25 ± 8.6 minutes) (p=0.224): In the 1st group: Graft pain, Perioral numbness Opening difficulties were reported in 75%, 75% 12.5% of the cases, respectively. The mean healing time of the donor site was 6.5 ± 2 days, the mean time of liquid tolerance was 1.62 ± 9.16 days, the mean time for catheter removal was 19.5 ± 2.77 days, the 1st group had statistically significant higher complications than the 2nd group (p= 0.0404). Success rate was higher in the 1st group (87.5 %) than the 2nd Group (75 %) with non-statistically significant difference between the both groups (p<0.05).Conclusion: The interposition of buccal mucosa graft could be more efficient safer as a second layer in vaginal repair of vesicovaginal fistula than Martius flap interposition.