Transpubic Access Using Pedicle Tubularized Labial Urethroplasty for the Treatment of Female Urethral Strictures Associated With Urethrovaginal Fistulas Secondary to Pelvic Fracture

Eur Urol. 2009 Jul;56(1):193-200. doi: 10.1016/j.eururo.2008.04.046. Epub 2008 Apr 30.

Abstract

Background: Female urethral injury is rare, and there is no accepted standard approach for the repair of urethral strictures.

Objective: To evaluate the efficacy of transpubic access using pedicle tubularized labial urethroplasty for urethral reconstruction in female patients with urethral obliterative strictures and urethrovaginal fistulas.

Design, setting, and participants: Between January 1996 and December 2006, eight cases of female urethral strictures associated with urethrovaginal fistulas were treated using pedicle labial skin flaps.

Interventions: A flap of approximately 3x3.5x3cm of the labia minora or majora with its vascular pedicle was tubularized over an 18-22 Fr fenestrated silicone stent to create a neourethra. This technique was used in five women. Two flaps, approximately 1.5-3.5 cm, were taken from bilateral labia minora or majora and were pieced together to create a neourethra. This technique was used in three patients.

Measurements: We performed voiding cystourethrography and uroflowmetry to assess postoperative results.

Results and limitations: The patients were followed up for 10-118 mo (mean 48.25 mo) after the procedure. There were no postoperative complications. Two patients complained of dysuria, which resolved spontaneously after 2 wk. One patient experienced stress incontinence that resolved after 4 wk. At 3-mo follow-up, one patient complained of difficulty voiding; the urinary peak flow was 13 ml/s, and the patient was treated successfully with urethral dilation. All other patients had normal micturition following catheter removal.

Conclusions: Pedicle labial urethroplasty is a reliable technique for the repair of extensive urethral damage, and a transpubic surgical approach provides wide and excellent exposure for the management of complex obliterative urethral strictures and urethrovaginal fistulas secondary to pelvic fracture.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical
  • Cystostomy / methods
  • Female
  • Follow-Up Studies
  • Fractures, Bone / complications*
  • Humans
  • Ischium / injuries*
  • Middle Aged
  • Mouth Mucosa / transplantation
  • Multiple Trauma / surgery*
  • Postoperative Care
  • Reconstructive Surgical Procedures / methods
  • Surgical Flaps
  • Treatment Outcome
  • Urethra / injuries
  • Urethra / surgery
  • Urethral Diseases / etiology
  • Urethral Diseases / surgery
  • Urethral Stricture / etiology
  • Urethral Stricture / surgery*
  • Vagina / injuries
  • Vagina / surgery
  • Vaginal Fistula / etiology
  • Vaginal Fistula / surgery*
  • Vulva / surgery
  • Young Adult