Surgical management of recurrent urethrovaginal fistula with a skin island flap

  • Alois Martan
  • Kamil Svabik
  • Libor Zamecnik
  • Jaromir MasataEmail author
IUJ Video


Introduction and hypothesis

A urethrovaginal fistula is a possible rare complication of tension-free vaginal tape procedures. Surgical management of these fistulas is sometimes complicated, and failure can occur. The operation is difficult when the defect between the urethra and the vagina is larger or scarred, so surgical intervention and the preferred technique are controversial.


The patient was referred to our department, where the first operation was performed to address the urethrovaginal fistula by the transvaginal and transabdominal approach with interposed omentum. This initial repair failed, resulting in a large urethrovaginal fistula with minimal redundant anterior vaginal wall to provide a tension-free closure. This video presentation describes the second operation—transvaginal repair of a large recurrent urethrovaginal fistula using the skin island flap technique.


The video of the procedure shows how to address a recurrent urethrovaginal fistula by employing a skin flap. An examination during the patient’s follow-up visit 3 months later revealed excellent healing and persistent stress urinary incontinence (SUI). Six months after the fistula repair, the patient underwent a bulking agent procedure.


The skin island flap procedure allowed the larger defect to heal, though it did not address the SUI, which was later treated by application of a bulking agent.


Native tissue repair Skin flap Urethrovaginal fistula 



This work was supported by Charles University in Prague, UNCE 204024.

Compliance with ethical standards

Conflicts of interest



Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Supplementary material


(MP4 99999 kb)


  1. 1.
    Blaivas JG, Mekel G. Management of urinary fistulas due to midurethral sling surgery. J Urol. 2014;192(4):1137–42.CrossRefGoogle Scholar
  2. 2.
    Estevez JP, Cosson M, Boukerrou M. An uncommon case of urethrovaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J. 2010;21(7):889–91.CrossRefGoogle Scholar
  3. 3.
    Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. Obstet Gynecol. 2011;13:143–8.CrossRefGoogle Scholar
  4. 4.
    Clifton MM, Goldman HB. Urethrovaginal fistula closure. Int Urogynecol J. 2017;28(1):157–8.CrossRefGoogle Scholar
  5. 5.
    Flisser AJ, Blaivas JG. Outcome of urethral reconstructive surgery in a series of 74 women. J Urol. 2003;169(6):2246–9.CrossRefGoogle Scholar
  6. 6.
    Latzko W. Postoperative vesicovaginal fistula: genesis and therapy. Am J Surg. 1942;58(2):211–28.CrossRefGoogle Scholar
  7. 7.
    Zilberlicht A, Lavy Y, Auslender R, Abramov Y. Transvaginal repair of a urethrovaginal fistula using the Latzko technique with a bulbocavernosus (Martious) flap. Int Urogynecol J. 2016;27:1925–7.CrossRefGoogle Scholar
  8. 8.
    Martius H. Die operative Wiederherstellung der vollkommen fehlenden Harnröhre und des Schiessmuskels derselben. Zentralbl Gynakol. 1928;52:480.Google Scholar
  9. 9.
    Knapstein PG, Friedberg V, Sevin BU. Reconstructive surgery in gynecology. Stuttgart: Georg Thieme Verlag; 1990. p. 281. ISBN. 978-3137495017.Google Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, 1st Faculty of MedicineCharles University and General University Hospital in PraguePragueCzech Republic
  2. 2.Department of Obstetrics and Gynecology, 1st Faculty of MedicineCharles University and General University Hospital in PraguePragueCzech Republic
  3. 3.Department of Urology, 1st Faculty of MedicineCharles University and General University Hospital in PraguePragueCzech Republic

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