title: Transvaginal bladder neck closure with posterior urethral flap for devastated urethra.
abstract: OBJECTIVE
  To present a modified transvaginal bladder neck closure (TV BNC) technique using a posterior urethral flap to minimize the potential risk of ureteral injury and fistula formation. Urethral and bladder neck destruction owing to chronic indwelling urethral catheters in female neurogenic patients is a devastating complication.
  
  
  METHODS
  A retrospective review was performed of all patients undergoing TV BNC at a single institution during a 3-year period. All patients had had a nonfunctional or destroyed urethra because of a long-term indwelling urethral catheter. In brief, the devastated outlet was closed using the dorsally bivalved urethra as a flap that was rotated cephalad onto the incised anterior bladder wall for closure, thereby rotating the suture line high into the retropubic space. A postoperative cystogram was obtained at 2-3 weeks.
  
  
  RESULTS
  A total of 11 consecutive female patients with a devastated outlet underwent TV BNC, as described, with placement of a suprapubic tube. One patient experienced failure at 6 weeks postoperatively. The mean follow-up for the entire cohort was 9.6 months (range 1-36). Serial upper tract imaging at the last follow-up visit revealed no new hydroureteronephrosis.
  
  
  CONCLUSIONS
  The results of our study have shown that TV BNC with a posterior urethral flap provides satisfactory early results. This technique creates a suture line far removed from the ureteral orifices, minimizing the risk of upper tract injury during closure. Also, the rotation of the posterior urethra onto the anterior bladder wall secures the suture line high into the retropubic space, minimizing the risk of failure and postoperative fistula formation.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. rovnere@musc.edu
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rovner
authors.forename: Colin M
authors.initials: CM
authors.lastname: Goudelocke
authors.forename: Alienor
authors.initials: A
authors.lastname: Gilchrist
authors.forename: Brett
authors.initials: B
authors.lastname: Lebed
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000293:injuries* / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization / Q000295:instrumentation; D013520:Urologic Surgical Procedures / Q000379:methods; D014621:Vagina