title: Reconstruction of Female Urethra with Tubularized Anterior Vaginal Flap.
abstract: BACKGROUND
  Female urethral injury is a rare disease. Causes of urethral injuries are prolonged obstructed labour, gynaecological surgeries like vaginoplasty and post traumatic urethral injuries. The present study was conducted to evaluate outcome of female urethral reconstruction using tubularized anterior vaginal wall flap covered with fibroadipose martius flap and autologous fascia sling in patients with urethral loss.
  
  
  OBJECTIVE
  Aim of study was to evaluate outcome of reconstruction of female urethra with tubularized anterior vaginal flap.
  
  
  METHODS
  Retrospective analysis of all the patients with complete urethral loss was done from August 2008 to July 2015. Total seven patients were included in study. All patients presenting with total urethral loss were included. These patients were treated with tubularized anterior vaginal flap. Neourethra was covered with Martius labial flap and autologous fascia lata or rectus abdominis fascia sling. Most common cause of urethral loss was obstructed labour (57.1%). Postoperatively patients were assessed for continence, urine flow rate, ultrasound for upper urinary tract and post void residue.
  
  
  RESULTS
  Mean operative time was 180 minutes (160-200 minutes) and Intraoperative blood loss was 220ml (170-260 ml). Mean postoperative hospital stay was eight days (seven to nine days) Mean post surgery maximum urine flow rate was more than 15ml/sec (6.7-18.2ml/sec) and mean post void residual urine was 22.5ml (10-50ml). Median follow-up time was 35 months. All patients were catheter free and continent post three weeks of surgery except one patient who developed mild stress urinary incontinence. One patient developed urethral stenosis which was managed by intermittent serial urethral dilatation.
  
  
  CONCLUSIONS
  Female neourethral reconstruction with tabularized anterior vaginal flap and autologous pubovaginal sling is feasible in patients of total urethral loss with success rate of approximately 86%. It should be considered in patients of complete urethral loss with adequate healthy vaginal tissue.
authors.affiliation: Professor and Head, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Ajit
authors.initials: A
authors.lastname: Sawant
authors.affiliation: Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Gaurav Vinod
authors.initials: GV
authors.lastname: Kasat
authors.affiliation: Associate Professor, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Vikash
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Assistant Professor, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Prakash
authors.initials: P
authors.lastname: Pawar
authors.affiliation: Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Ashwin
authors.initials: A
authors.lastname: Tamhankar
authors.affiliation: Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Sumit
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Lomesh
authors.initials: L
authors.lastname: Kapadnis
authors.affiliation: Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College (LTMMC) , Mumbai, India .
authors.forename: Abhishek
authors.initials: A
authors.lastname: Savalia
keywords: Female neourethra; Female urethral loss; Female urethral reconstruction; Martius flap