New Technique for Reconstruction of the Female Urethra

Abstract

Defects of the female urethra includes wide variety of conditions, from small urethrovaginal fistulas to losses of total urethra and bladder neck. Failed surgical repairs produce more loss of tissue than the original traumas. We present an unusual case series of complicated urethrovaginal fistulas, which were treated using labial skin flaps supported by maritus pads of fat. A young girl had an accident producing a traumatic urinary fistula in her left thigh. Surprisingly, this was a continent type of fistula, the patient voided through the fistula naturally. There was total loss of the urethra with a bony block. A portion of bone was removed to approach the bladder neck and her urethra was reconstructed using a labial skin flap supported by a martius pad of fat. Subsequently, this technique was used in 4 other cases of complex urethrovaginal fistulas of various etiologies. This is a totally new technique used to reconstruct the urethra and is useful when other simple techniques may not work or are associated with very high failure rates. The technique can be used to bridge even very large urethral defects. Such use of labial skin to reconstruct the female urethra has not been reported earlier. (J GYNECOL SURG 22:23)