INTRODUCTION:
Reconstructive  surgeries  in vagina is unlike other vaginal surgeries due to its different anatomy and changes due to fistula. Urological surgeons collaborate to improve surgical outcomes regarding vesicovaginal fistula. Controversies regarding different interposition flaps still exist. Martius pad fat technique shows promising results  in terms of recurrence in patients with obstetric and gynecological fistulas and post-operative hospital stay.
OBJECTIVE
    To determine the outcomes of vesicovaginal fistula repair  using martius pad fat in terms of fistula recurrence and post-operative hospital stay.

This study is conducted at Hayatabad Medical complex/ institute of kidney diseases Peshawar from 1st July 2012 to 31st august 2022.Fifty  seven patients underwent martius pad fat as interposition flap as an elective procedure. All the patients were evaluated for different outcome variables such recurrence and post-operative hospital stay.All the informations were collected through pre designed proforma. Data was entered through SPSS 22 version.

Martius pad fat is used was used as interposition flap for vesicovaginal fistulas in 57 patients. All fistulas were developed postoperatively after total abdominal hysterectomy(47 cases) and caesarean section(10 cases). vaginal approach was adapted in all the cases. Mean hospital stay was four  days(range 3 to 5). Fistula recurred in three  patients while no fistula recurrence is noted in remaining 54 patients(94.7%) in a mean follow up of 60 days(range 55 to 120). Twenty five  patients had voiding abnormalities post operatively which were improved with anticholinergics.

Martius pad fat was used as an interposition flap to treat vesicovaginal fistulas in 57 patients. The fistulas had developed postoperatively after total abdominal hysterectomy (47 cases) and caesarean section (10 cases). The surgery was performed through the vaginal approach in all cases, and the mean hospital stay was four days (ranging from three to five days).
After the surgery, fistula recurrence was observed in three patients, while the remaining 54 patients (94.7%) did not experience any recurrence during a mean follow-up period of 60 days (ranging from 55 to 120 days).
Additionally, 25 patients experienced voiding abnormalities after the surgery, which were improved with anticholinergics

Martius pad fat  is an effective tool  for reconstruction of obstetric fistulas with less post operative hospital stay and decreased chances of recurrence. More randomized clinical trials are suggested in this area to make this as standardized procedure.
The success of any surgical procedure depends on various factors, such as the extent and location of the fistula, the patient's overall health status, and the surgeon's expertise. Therefore, the use of Martius pad fat should be carefully evaluated and individualized based on each patient's unique situation.