Introduction & Objective :
Fistulas are a common complication following bladder neck transection (BNT), and methods of tissue interposition are utilized to decrease fistulization rates post-operatively. The purpose of this study is to evaluate Human Acellular Dermis (HAD) as an adjunct during BNT by comparing its surgical outcomes with other types of tissue interposition.
A prospectively-maintained institutional database of Exstrophy-Epispadias Complex (EEC) patients was reviewed for those who underwent a BNT with at least 6 months follow-up. The primary outcome was the occurrence of BNT-related fistulas.
In total, 147 EEC patients underwent a BNT with a mean follow-up time of 6.9 years (range 0.52 years to 23.35 years). There were 124 (84.4%) classic exstrophy patients, 22 (15.0%) cloacal exstrophy patients, and 1 (0.7%) penopubic epispadias patient. A total of 12 (8.2%) BNTs resulted in fistulization, including 4 vesicoperineal fistulas, 7 vesicourethral fistulas, and one vesicovaginal fistula. There were 5 (22.7%) fistulas in the cloacal extrophy cohort, and 7 (5.6%) fistulas in the classic bladder exstrophy cohort (p=0.019). Using either HAD or native tissue flaps resulted in a lower fistulization rate than using no interposed layers (5.8% vs 20.8%; p=0.039). Of those with HAD, the use of a fibrin sealant did not decrease fistulization rates when compared to HAD alone (6.5% vs 8.8%, p=0.695). There was no statistical difference in surgical complications between the use of HAD and native flaps (8.6% vs 5%, p=0.716).
Use of soft tissue flaps and HAD is associated with decreased fistulization rates after BNT. HAD is a simple option and an effective adjunct that does not require harvesting of tissues in patients where a native flap is not feasible.