Vaginal flap reconstruction of the urethra and vesical neck in women: a report of 49 cases.
OBJECTIVE
A retrospective study was done to evaluate the results of a 1-stage urethral reconstruction in women.


METHODS
Of 49 consecutive women who presented with anatomical damage to the urethra or vesical neck 48 underwent urethral and/or vesical neck reconstruction with vaginal flaps. A Martius labial fat pad flap was used in 47 patients, a gracilis flap in 1 and an anterior bladder tube in 1. In 41 patients the anti-incontinence procedure consisted of a fascial pubovaginal sling placed over the labial fat pad flap without tension. In 5 patients a modified Pereyra operation was done and 1 underwent a Kelly plication. Followup ranged from 1 to 11 years.


RESULTS
Postoperatively continence was obtained in 42 of 49 patients (87%). The initial procedure failed in 7 patients and a secondary procedure was successful in 6. Of the 5 initial patients who underwent a modified Pereyra operation 3 had postoperative stress incontinence and all were cured subsequently by a pubovaginal sling.


CONCLUSIONS
A 1-stage vaginal flap reconstruction and pubovaginal sling procedure is effective in women with extensive vesical neck and/or urethral damage.
Blaivas
J G
JG
Department of Urology, New York Hospital/Cornell University Medical Center, New York, USA.
Heritz
D M
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods*; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery*; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery*; D001747:Urinary Bladder Fistula / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D014621:Vagina / Q000601:surgery