[Comparative study of the outcome of surgical management of vesico-vaginal fistulas with and without interposition of the Martius graft: A Cameroonian experience].

INTRODUCTION: This study aimed to investigate whether Martius' graft has an effect on the outcome of the surgical management of genitourinary fistula.

PATIENTS AND METHODS: This was a retrospective comparative study of all cases of genitourinary fistula that underwent curative surgery in two Cameroonian hospitals. Patients were all operated between January 2005 and July 2011 in the gynecology unit of the Maroua Regional Hospital and the University Hospital Centre of Yaoundé by a well-trained surgeon. The characteristics of women with fistulas operated without graft of Martius were compared with those of women operated with graft of Martius.

RESULTS: Among the 81 genitourinary fistulas operated, 28 (34.6%) had benefited from graft of Martius. Depending on the characteristics of obstetric fistula, the two groups (that of patients who had a cure with, and that of patients who had a cure without interposition of graft of Martius) were similar: there was no difference in the proportion of rigid edges (89.3% vs. 73.6%, P=0.0989); in the proportion of vaginal flanges (78.6% vs. 60.4%, P=0.0986), in the proportion of cervical localization (42.9% vs. 28.3%, P=0.3762), in the proportion of fistulas with a size greater than 2 cm (64.3% vs. 39.6%, P=0.0702), nor in the proportion of recurrent fistulas (28.6% vs. 41.5%, P=0.2523) between the two groups. Similarly, both groups were comparable according to the results of surgery: there was no difference in the overall closure rate (85.7% vs. 79.2%, P=0.347) nor in the closure of fistula with continence (60.7% vs. 67.9%, P=0.260) between the two groups. The use of graft of Martius had no effect on the overall closure of genitourinary fistula in our series [OR: 1.57; 95% CI: 0.4 to 6.6; P=0.680].

CONCLUSION AND INTERPRETATION: The Martius graft does not seem to affect the outcome of the surgical management of genitourinary fistula. These results need to be confirmed by studies on a larger population.