Martius Labial Fat Pad Use in the Treatment of Complications Associated With Prior Surgery for Urinary Incontinence or Pelvic Organ Prolapse.

Objective: To evaluate the outcomes of Martius Labial Fat Pad (MLFP) in the treatment of complications related to surgery for urinary incontinence (UI) and/or pelvic organ prolapse (POP) and to assess the influence of mesh presence.

Methods: Following institutional review board approval (n° STU 2023 1280), a review of all women who underwent an MLFP procedure at our tertiary center after UI and/or POP repair was performed by an independent investigator. The primary outcome was the rate of post-operative complications classified according to the Clavien-Dindo classification. Secondary outcomes were based on indications and functional results. A sub-group analysis was performed according to the type of prior repair: mesh or native tissue repair.

Results: From 2006-2022, 26 patients underwent a MLFP procedure, with a median follow-up duration of 30 (12-67.5) months. Bladder outlet obstruction and fistulae were the 2 most frequent indications. Post-operative complications occurred in 15 patients (58%): grade I in 6 (43%), grade 2 in 3 (21%), grade 3b in 4 (29%) and grade 4b in 1 (7%). Four of the grade ≥3 complications occurred in the mesh group. Median operative time was longer in the mesh group: 200 minutes (177.5-229.5) versus 146 minutes (128-190) (P = .03) and the success rate was lower: 61% versus 85% (P = .06). Overall, surgery was successful in 19 patients (73.8%).

Conclusion: MFLP is a reliable flap in specialized indications after UI and/or POP repair procedures with a higher risk of major complications and a lower success rate in women previously operated with mesh.