One stage reconstruction of the urethra and bladder neck, following severe obstetric trauma (SIU 2010)
- uploaded: Oct 9, 2010
- Views: 1290
Institution:Urology and Nephrology Center, Mansoura, Egypt
Introduction and Objective:
Severe trauma involving female urethra is dreadful. Restoration of the anatomical integrity is never enough without keeping an acceptable degree of continence as well. Many staged procedures were described to achieve this goal but one stage reconstruction was also reported with remarkable success . This video demonstrates one stage repair of a severe form of urethral tissue loss.
Patients and Methods:
This video shows a case of 25- year old woman who had an obstructed labor, ended by massive urethral bladder neck disruption and total incontinence is demonstrated in this video.
Dorsal urethral plate was intact. Reconstruction was planned so that this healthy part is made use of. A pedicled vaginal flap was harvested to replace the ventrum of the urethra, and was anastmosed to the dorsal flap. Bladder neck was adherent to the back of symphysis, so it was severed and reanastmosed to the dorsal urethral wall. Rectus fascia sling was utilized to accomplish continence.
Postoperative course was uneventful. 6 Months after surgery, the patient is dry day and night. The patient was instructed to adopt Valsalvaâ€™s maneuver during voiding.
Vaginal lumen was wide enough to allow for normal intercourse without reported dyapareunia.
One stage reconstruction of complex female urethral injury is technically demanding and is potentially successful, provided that different techniques of reconstruction and anti-incontinence procedures are at hand.
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