title: Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra.
abstract: OBJECTIVE
  Vulvar cancer is a relatively rare tumour accounting for just 5% of all gynaecological malignancies. Radical excision can sometimes involve the distal one-third to one-half of the urethra leading to postoperative problems with micturition, asymmetries and psychosexual distress. Although this topic has been largely addressed, no specific method for distal urethra reconstruction has been described. The aim of this paper is to assess the safety and reliability of our reconstructive technique.
  
  
  METHODS
  We conducted a retrospective study of 47 consecutive patients who underwent neourethral meatus reconstruction with vaginal mucosa flap. The surgical technique is described step-by-step. We reviewed the patients' demographics, operative characteristics, as well as immediate complications and long-term outcomes.
  
  
  RESULTS
  Neo-meatal reconstruction was combined to direct vulvar closure in 2 patients, rhomboid flaps in 3 cases, 1 bilateral lotus flap and 36 V-Y fasciocutaneous flaps, 4 rectus abdominis and 1 gracilis flap. Wound dehiscence at the site of the neourethral reconstruction occurred in only 4.3%, partial necrosis of the vaginal mucosa flap in 2.1%. Totally post-operative early complication rate including the whole procedures was 29.8% with a re-operation rate of 4.3%. Long-term outcomes were evaluated in 68.1% patients, including 18.7% of urinary incontinence, no urethral stenosis and 25% of narrowed vaginal introitus.
  
  
  CONCLUSIONS
  Neourethral meatus reconstruction using the vaginal mucosa flap is a simple, safe and reliable technique with a very low early complication rate. We suggest that this flap could be a good option to preserve and restore urinary function in case of distal urethral amputation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: francesca.delorenzi@ieo.it.
authors.forename: F
authors.initials: F
authors.lastname: de Lorenzi
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: pietro.loschi@ieo.it.
authors.forename: P
authors.initials: P
authors.lastname: Loschi
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: mario.rietjens@ieo.it.
authors.forename: M
authors.initials: M
authors.lastname: Rietjens
authors.affiliation: European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: claudia.sangalli@ieo.it.
authors.forename: C
authors.initials: C
authors.lastname: Sangalli
authors.affiliation: Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: andrea.manconi@ieo.it.
authors.forename: A
authors.initials: A
authors.lastname: Manconi
authors.affiliation: Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: vanna.zanagnolo@ieo.it.
authors.forename: V
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: mariateresa.achilarre@ieo.it.
authors.forename: M T
authors.initials: MT
authors.lastname: Achilarre
authors.affiliation: Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: angelo.maggioni@ieo.it.
authors.forename: A
authors.initials: A
authors.lastname: Maggioni
authors.affiliation: Department of Gynecology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: fabio.landoni@ieo.it.
authors.forename: F
authors.initials: F
authors.lastname: Landoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014521:Urethra / Q000601:surgery*; D014844:Vulva / Q000601:surgery*; D014846:Vulvar Neoplasms / Q000601:surgery*
keywords: Flap; Neo-meatal reconstruction; Reconstruction; Vulvar cancer