World Journal of Urology

, Volume 23, Issue 4, pp 231–235 | Cite as

Management of neobladder-vaginal fistula and stress incontinence following radical cystectomy in women: a review

  • Hari S. G. R. Tunuguntla
  • Murugesan Manoharan
  • Angelo E. Gousse
Review
First Online:
Received:
Accepted:

Abstract

Contemporary literature regarding the management of neobladder-vaginal fistula and stress urinary incontinence following radical cystectomy and neobladder reconstruction in women is reviewed in this article. Neobladder-vaginal fistula is uncommon but mandates meticulous repair. Compared to the native bladder, the wall of the neobladder is much thinner that may render it vulnerable to fistulization. Preservation of the anterior vaginal wall during radical cystectomy decreases the likelihood of pouch-vaginal fistula. Omental flap interposition between the vaginal stump and neobladder at cystectomy may not always prevent fistulization if anterior vaginal wall is violated or overlapping suture lines are not avoided. Surgery for intractable stress incontinence following neobladder reconstruction is fraught with severe complications and requires judicious use of allograft pubovaginal slingplasty possibly with bone anchors. Martius flap interposition appears to play a crucial role in improving the outcome following transvaginal repair of the neobladder-vaginal fistula in multiple non-overlapping layers.

Keywords

Radical cystectomy Neobladder Neobladder-vaginal fistula Vagina Martius flap Slingplasty 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Ali-El-Dein B, el-Sobky E, Hohenfellner M, Ghoneim MA (1999) Orthotopic bladder substitution in women: functional evaluation. J Urol 161:1875CrossRefPubMedGoogle Scholar
  2. 2.
    Blute ML, Gburek BM (1998) Continent orthotopic urinary diversion in female patients: early Mayo Clinic experience. Mayo Clin Proc 73:501PubMedCrossRefGoogle Scholar
  3. 3.
    Chang SS, Cole E, Cookson MS, Peterson M, Smith JA Jr (2002) Preservation of the anterior vaginal wall during female radical cystectomy with orthotopic urinary diversion: technique and results. J Urol 168:1442–1445CrossRefPubMedGoogle Scholar
  4. 4.
    Hautmann RE, Paiss T, de Petriconi R (1996) The ileal neobladder in women: 9 years of experience with 18 patients. J Urol 155(1):76–81CrossRefPubMedGoogle Scholar
  5. 5.
    Hautmann RE, de Petriconi R, Gottfried HW, Kleinschmidt K, Mattes R, Paiss T (1999) The ileal neobladder: complications and functional results in 363 patients after 11 years of followup (discussion 427–428). J Urol 161(2):422–427CrossRefPubMedGoogle Scholar
  6. 6.
    Lee CT, Hafez KS, Sheffield JH et al (2004) Orthotopic bladder substitution in women: nontraditional applications. J Urol 171:1585–1588CrossRefPubMedGoogle Scholar
  7. 7.
    Mills RD, Studer UE (2000) Female orthotopic bladder substitution: a good operation in the right circumstances. J Urol 163:1501CrossRefGoogle Scholar
  8. 8.
    Pruthi RS, Petrus CD, Bundrick WS Jr (2000) New onset vesicovaginal fistula after transurethral collagen injection in women who underwent cystectomy and orthotopic neobladder creation: presentation and definitive treatment. J Urol 164:1638–1639CrossRefPubMedGoogle Scholar
  9. 9.
    Quek ML, Ginsberg DA, Wilson S, Skinner EC, Stein JP, Skinner DG (2004) Pubovaginal slings for stress urinary incontinence following radical cystectomy and orthotopic neobladder reconstruction in women. J Urol 172:219–221CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hari S. G. R. Tunuguntla
    • 1
  • Murugesan Manoharan
    • 2
  • Angelo E. Gousse
    • 1
  1. 1.Division of Female Urology, Voiding Dysfunction and Reconstructive Urology, Department of Urology School of MedicineUniversity of MiamiMiamiUSA
  2. 2.Division of Urologic Oncology, Department of Urology School of MedicineUniversity of MiamiMiamiUSA

Personalised recommendations