Modified pubovaginal sling and Martius graft for repair of the recurrent vesicovaginal fistula involving the internal urinary sphincter.

A modified Martius graft interposition flap was used in conjunction with the modified pubovaginal sling bladder suspension to treat a recurrent vesicovaginal fistula involving the proximal urethra and bladder neck. The patient recovered with no incontinence, voiding dysfunction or dyspareunia. Incontinence should be anticipated with vesicovaginal fistulas involving the internal sphincter and repair should be tailored to include an organic suburethral sling.