Bulbocavernosus Muscle Flap for the Repair of Vesicovaginal Fistula

Abstract

Introduction: Anatomical studies on the bulbocavernosus muscle (BCM) and its supporting blood vessels were performed to explore the clinical roles of BCM flaps in the repair of complicated vesicovaginal fistulas. Methods: BCM and the supporting blood vessels of 15 female adult cadavers were anatomized. Pedicled BCM flaps were transposed to repair complicated vesicovaginal fistulas in 11 patients. Results: The left side of BCMs was 9.1 ± 1.8 cm in length and 1.5 ± 0.2 cm in width, whereas the right side was 9.0 ± 1.9 cm in length and 1.5 ± 0.4 cm in width. No significant difference between the two sides was identified (p > 0.05). The bulbocavernosus (BC) artery forms an angle with the superficial transverse perineal muscle at 64 ± 14° to the left and 68 ± 15° to the right. No significant difference between the two sides was found (p > 0.05). None of the 11 patients reported any postoperative urine leakage in the vagina or urinary incontinence. Follow-ups ranging from 6 months to 10 years found no urinary incontinence or urethral stricture; all patients have normal sexual function. Conclusion: Anatomical studies of BCM and its supporting blood vessels provide useful data for clinical application, especially the reduction of muscle flap death and the increase in the cure rate of complicated vesicovaginal fistulas.