Abstract
Browning et al describe procedures for prevention of incontinence in women undergoing obstetric fistula (OF) repair or treatment of women who have residual incontinence after successful fistula closure. Their premise is that scarring and decreased elasticity of the anterior vagina results in opposing forces on the urethra thereby causing incontinence—the so called Integral Theory. By employing a rotational skin flap from the adjacent thigh, the vaginal wall elasticity is restored. Their technique does not include the fascial portion of the flap which is widely considered to be important for preservation of the blood supply. They also describe the restoration of the pubo-urethral ligament using a pubococcygeal sling or rectus sheath and recreation of the urethra with bladder smooth muscle when necessary. Browning has previously described success with the pubococcygeal sling procedure (Browning BJOG, 2004; 111: 357-61) for the prevention of post-operative incontinence, but this goes a step further in terms of surgical complexity and improved early outcomes. This article is protected by copyright. All rights reserved.
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