Purpose: To assess the indications, morbidity, efficacy and outcomes of Martius fat pad (MFP) interposition in reconstructive female urology.
Materials and methods: Data on 159 women with MFP interposition as part of their primary procedure between 2 September 2005 and 2 July 2015 were prospectively collected. Patient demographics and the indications for MFP interposition along with the outcomes of their primary procedures and short- and long-term complications related to the MFP, along with patient reported perception of post-operative appearance, were noted.
Results: The main indications for MFP interposition were urethral diverticulum excision (74), vaginal repair of vesicovaginal fistula (VVF) (43), removal and repair of urethral erosion of mid-urethral tape (MUT) (24), female urethroplasty for stricture (12), vaginal closure of bladder neck for complex end-stage stress urinary incontinence (USUI) (4) and as a MUT wrap for protection of urethra and vagina in women with fragile urethras (2). The majority of patients (127 or 79 %) rated the post-operative appearance of their labia as good or excellent. Only 1 patient (0.6 %) felt the post-operative appearance was unsatisfactory. There were 2 post-harvest labial haematoma (1.25 %), 1 labial wound infection in an overweight diabetic patient (0.6 %) and no other significant short- or long-term complications.
Conclusions: MFP interposition is associated with good cosmesis and a very low complication rate (<2 %). It appears to lower new onset post-procedure USUI, prevent erosion in the 'fragile' urethra and improve outcomes following repair of post-surgery VVF/UVF. MFP is a versatile and effective tool in the female urologists' armamentarium.
Keywords: Diverticulum; Fistula; Incontinence; Martius fat pad.