Vaginal reconstruction using the bladder and/or rectal walls in patients with radiation-induced fistulas

Gynecol Oncol. 2000 Sep;78(3 Pt 1):356-60. doi: 10.1006/gyno.2000.5920.


Objective: In irreparable or recurrent vesicovaginal fistulas and cloacal defects following high-dose irradiation therapy for gynecological malignancies, urinary diversion is the last resort to achieve a socially acceptable solution. In a select group of young and tumor-free patients, additional vaginal reconstruction may be indicated. Multiple operative procedures are available, but the results are often disappointing in the previously irradiated area.

Materials and methods: In six such patients with large radiogenic vesicovaginal defects (n = 5) or a cloacal fistula (n = 1), a continent reservoir using the transverse colon with an umbilical stoma was performed. At the end of the operation, the bladder was incorporated into a neovagina by incising the urethra, anterior vaginal wall, and the posterior bladder wall with electrocautery from the urethral meatus to the dome of the fistula.

Results: No postoperative complications related to the vaginal reconstruction occurred. After a mean follow-up of 4.7 years, all patients had a capacious vagina and a wide introitus; the neovagina measured a mean of 18 cm in length. Five patients with a partner reported a normal sexual life. No dyspareunia or discomfort from bladder or urethral mucosa during intercourse was reported.

Conclusions: Following continent urinary diversion due to irreparable vesicovaginal fistulas, a neovagina can be created by simple dissection of the posterior bladder and anterior vaginal wall. When a colostomy is present, the neovagina can additionally be augmented with a bowel flap of the Hartmann stump or by incising the rectovaginal septum. The technique affords good functional and cosmetic results.

MeSH terms

  • Cloaca / radiation effects
  • Cloaca / surgery
  • Female
  • Humans
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods*
  • Radiation Injuries / etiology
  • Radiation Injuries / surgery*
  • Rectum / surgery*
  • Urinary Bladder / radiation effects
  • Urinary Bladder / surgery*
  • Urinary Diversion
  • Uterine Cervical Neoplasms / radiotherapy
  • Uterine Cervical Neoplasms / surgery
  • Vagina / radiation effects
  • Vagina / surgery*
  • Vesicovaginal Fistula / etiology
  • Vesicovaginal Fistula / surgery*