Results of bladder neck reconstruction using bladder flaps in complex female urethral defects
- PDF / 734,287 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 36 Downloads / 203 Views
ORIGINAL ARTICLE
Results of bladder neck reconstruction using bladder flaps in complex female urethral defects Vijay Patidar 1 & Sabby Dias 1 & Shivanand Prakash 1 & Lalit Kumar 1 & Udai Shankar Dwivedi 1 & Sameer Trivedi 1 Received: 31 July 2020 / Accepted: 14 September 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Female urethral defects are rare, congenital defects being more uncommon than acquired, and difficult to manage. Most female urethral defects are associated with incontinence or acute urinary retention. There is a lack of standard protocol-based management of female urethral defects because of limited experience. In this study, we describe our results of using anterior or posterior bladder wall flaps in the management of a variety of female urethral defects. Methods We reviewed the case records of 22 patients who had undergone either anterior or posterior bladder wall-based flap procedures for complex urethral defects at our institute. Patients were assessed by taking a comprehensive history including aetiological factors and details of prior surgical intervention, thorough physical and pelvic examination, cysto-urethroscopy and relevant imaging. These factors, along with availability and status of tissue available for reconstruction affected the selection of procedure for reconstruction. Results Out of 22 patients, anterior and posterior bladder flaps were used in 16 and 6 patients respectively. A total of 18 patients became socially dry and 15 achieved complete continence after removal of the catheter and were voiding satisfactorily, whereas the remaining 4 patients had incontinence postoperatively. An additional 3 out of 18 patients had minimal stress incontinence requiring conservative treatment and 2 patients developed voiding difficulty requiring self-calibration. Conclusions Female urethral defects with bladder neck involvement are complex and challenging to manage. Bladder wall-based flaps offer a good chance of successful repair of these complex urethral defects. Keywords Bladder wall flaps . Pelvic fracture . Urethral coitus . Urethral defect . Urinary incontinence
Abbreviations PVRU Post-void residual urine PV sling Pubo-vaginal sling SPC Suprapubic cystostomy VCUG Voiding cystourethrogram
Introduction Female urethral and bladder neck reconstruction is a challenging and difficult task. Since the first report by Young in 1922 [1], a variety of procedures have been described in the * Sameer Trivedi [email protected] 1
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
published literature for female urethral reconstruction [2–5]. Following description of clean intermittent catheterisation by Lapides et al. in 1972 [6], many procedures were described that focused on bladder neck reconstruction for continence and use of clean intermittent catheterisation for voiding. Female urethral defects may be congenital or acquired. Most common acquired causes of the female ureth
Data Loading...
