Demchenko V. Surgical treatment of vesicovaginal fistula with the use of multicomponent biological wound patch.

The thesis is dedicated to solution of the problem of surgical treatment of patients with vesicovaginal fistula (VVF) using the suggested method of fistuloplasty with the use of multicomponent biological wound patch (MCBWP). The provided results are of investigation and treatment of 60 patients with vesicovaginal fistula. It has been discovered that the use of MCBWP in surgical treatment of VVF significantly (p<0,05) decreases the rate of postoperative relapses (6,7%), in comparison with conventional methods (30%), it has good plastic, haemostatic and tissue-sealing properties, that do not alter upon contact with urine and achieves permanent effect within 3-5 minutes after use. Variable adhesive activity of MCBWP to different layers of bladder wall has been determined: weak fixation to undamaged mucosa and strong fixation to submucosal, muscular and serous layers. The clinical absence of significant biological safety and absence of allergic and toxic reactions were clinically approved. It was established that the following factors influence the results of surgical treatment: patient's age, previous postoperative relapses, postoperative fistulas, time from fistula formation or relapse to operation, and the size of a fistula. On the basis of provided data discriminate equations were suggested to make prognosis of the results of treatment even before the operation with a high degree of accuracy (p<0,05). This allows to decrease the risk of relapse with the use of multicomponent biological wound patch in case of unfavorable prognosis.