Abstract
<title>Abstract</title> <p> Objectives To identify predictive factors for neovesico-vaginal fistula (nVVF) in female patients with ileal orthotopic neobladder (IONB) and introduce autologous peritoneal graft (APG) interposition as a potential preventive technique. Materials and Methods Female bladder cancer patients who underwent radical cystectomy and IONB between January 2010 and December 2022 were reviewed. The surgical methods were practically uniform; initial extraperitoneal approach for pelvic lymph-node dissection and ureter ligation, and peritoneum was later opened for further procedures. In cases of APG interposition, the peritoneum was harvested large enough to cover the vaginal cuff just before bowel manipulation. The incidence, characteristics, and predictive factors for nVVF were analyzed. Results A total of 175 patients (control; n = 118, APG; n = 57; mean age: 63.9 ± 10.1 years) were included. More patients in the APG group received neoadjuvant chemotherapy (40.4% vs. 20.3%, <italic>p</italic> = 0.005), but the incidence of nVVF was lower (20.3% vs. 3.5%, <italic>p</italic> = 0.002) than control. On multivariate analysis, old age (odds ratio (OR) 1.050; 95% confidence interval (CI): 1.001–1.101, <italic>p</italic> = 0.045) and neoadjuvant chemotherapy (OR 4.031; 95% CI: 1.448–11.219, <italic>p</italic> = 0.008) were risk factors for nVVF, whereas peritoneal graft interposition (OR 0.094; 95% CI: 0.020–0.439, <italic>p</italic> = 0.003) was a preventive factor. Conclusions APG interposition between the vaginal stump and neobladder is a promising technique to prevent nVVF in female IONB surgery. Old age and neoadjuvant chemotherapy might have negative effects on the healing process of female IONB. </p>