Persistent bladder dysfunction after Martius flap repair for a radiation-induced vesicovaginal fistula: A case report

Radiation-induced vesicovaginal fistulae represent one of the most challenging complications of pelvic surgery because irradiated tissues exhibit severe fibrosis, ischemia, and impaired healing. Among various surgical techniques, Martius flap repair is widely employed because it provides a well-vascularized tissue buttress and enhances closure rates. However, while most reports have focused on anatomical success, little attention has been paid to the long-term bladder function after closure. We describe the case of a 50-year-old woman who developed a radiation-induced vesicovaginal fistula after chemoradiotherapy for cervical cancer. The fistula was successfully closed using a Martius flap, and no further vaginal leakage was observed. Nevertheless, during follow-up, she developed persistent bladder dysfunction, characterized by reduced compliance, detrusor overactivity, and nocturnal urinary leakage, which was confirmed by serial urodynamic evaluations. This case illustrates a discrepancy between anatomical closure and functional outcomes. Even after technically successful repairs, latent bladder dysfunction may persist and place patients at risk of upper urinary tract deterioration. Our report emphasizes the importance of incorporating systematic urodynamic follow-up into postoperative care, particularly for complex or irradiated fistulas, to ensure anatomical and functional success. • Successful anatomical closure of a radiation-induced vesicovaginal fistula does not always restore normal bladder function. • Postoperative urodynamic evaluations are imperative to detect latent dysfunction. • This is particularly important for younger women to preserve their long-term urinary tract health.